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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Surgical Patholog","code_information":[{"code":"960451","type":"CDM"},{"code":"312","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"gross_charge":134.13,"discounted_cash":80.48,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Surgical Patholog","code_information":[{"code":"960452","type":"CDM"},{"code":"312","type":"RC"},{"code":"88307","type":"CPT"}],"standard_charges":[{"gross_charge":1061.56,"discounted_cash":636.94,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Surgical Patholog","code_information":[{"code":"960453","type":"CDM"},{"code":"312","type":"RC"},{"code":"88309","type":"CPT"}],"standard_charges":[{"gross_charge":2432.64,"discounted_cash":1459.58,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Chromosome Analys","code_information":[{"code":"960510","type":"CDM"},{"code":"310","type":"RC"},{"code":"88237","type":"CPT"}],"standard_charges":[{"gross_charge":415.09,"discounted_cash":249.05,"setting":"both","modifier_code":["90"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 90: Reference (Outside) Laboratory"}]},{"description":"Pathology Billing Chromosome Micros","code_information":[{"code":"960511","type":"CDM"},{"code":"310","type":"RC"},{"code":"88262","type":"CPT"}],"standard_charges":[{"gross_charge":594.98,"discounted_cash":356.99,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Chromosome Analys","code_information":[{"code":"960512","type":"CDM"},{"code":"310","type":"RC"},{"code":"88233","type":"CPT"}],"standard_charges":[{"gross_charge":452.82,"discounted_cash":271.69,"setting":"both","billing_class":"facility"}]},{"description":"Recut, Unstained per slide","code_information":[{"code":"960515","type":"CDM"},{"code":"310","type":"RC"},{"code":"88399","type":"CPT"}],"standard_charges":[{"gross_charge":41.27,"discounted_cash":24.76,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Recut, Stained per slide","code_information":[{"code":"960516","type":"CDM"},{"code":"310","type":"RC"},{"code":"88399","type":"CPT"}],"standard_charges":[{"gross_charge":68.78,"discounted_cash":41.27,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing 88142 PAP Reproce","code_information":[{"code":"960517","type":"CDM"},{"code":"311","type":"RC"},{"code":"88142","type":"CPT"}],"standard_charges":[{"gross_charge":98.59,"discounted_cash":59.15,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing 88333 Touch Prep","code_information":[{"code":"960518","type":"CDM"},{"code":"310","type":"RC"},{"code":"88333","type":"CPT"}],"standard_charges":[{"gross_charge":1766.59,"discounted_cash":1059.95,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing 88334 Touch Prep","code_information":[{"code":"960519","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"CPT"}],"standard_charges":[{"gross_charge":143.3,"discounted_cash":85.98,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Non-Gyn Cytology","code_information":[{"code":"960524","type":"CDM"},{"code":"311","type":"RC"},{"code":"88112","type":"CPT"}],"standard_charges":[{"gross_charge":175.4,"discounted_cash":105.24,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing 88177 FNA Immed R","code_information":[{"code":"960538","type":"CDM"},{"code":"311","type":"RC"},{"code":"88177","type":"CPT"}],"standard_charges":[{"gross_charge":82.54,"discounted_cash":49.52,"setting":"both","billing_class":"facility"}]},{"description":"Pathology Billing Immunoperoxidase(","code_information":[{"code":"960551","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"CPT"}],"standard_charges":[{"gross_charge":206.35,"discounted_cash":123.81,"setting":"both","billing_class":"facility"}]},{"description":"Pathology Billing Handling and Tran","code_information":[{"code":"960653","type":"CDM"},{"code":"300","type":"RC"},{"code":"99001","type":"CPT"}],"standard_charges":[{"gross_charge":33.24,"discounted_cash":19.94,"setting":"both","billing_class":"facility"}]},{"description":"Pathology Billing Recut Block & Con","code_information":[{"code":"960700","type":"CDM"},{"code":"310","type":"RC"},{"code":"88399","type":"CPT"}],"standard_charges":[{"gross_charge":361.11,"discounted_cash":216.67,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Stones Gross Only","code_information":[{"code":"968021","type":"CDM"},{"code":"312","type":"RC"},{"code":"88300","type":"CPT"}],"standard_charges":[{"gross_charge":68.78,"discounted_cash":41.27,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Decalcification","code_information":[{"code":"968038","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"CPT"}],"standard_charges":[{"gross_charge":40.12,"discounted_cash":24.07,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Special Stains Gr","code_information":[{"code":"968040","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"CPT"}],"standard_charges":[{"gross_charge":233.87,"discounted_cash":140.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Immunoperoxidase","code_information":[{"code":"968644","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"}],"standard_charges":[{"gross_charge":405.82,"discounted_cash":243.49,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Tissue Imprint(pr","code_information":[{"code":"968652","type":"CDM"},{"code":"311","type":"RC"},{"code":"88161","type":"CPT"}],"standard_charges":[{"gross_charge":165.08,"discounted_cash":99.05,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing 88363 Review of A","code_information":[{"code":"968697","type":"CDM"},{"code":"310","type":"RC"},{"code":"88363","type":"CPT"}],"standard_charges":[{"gross_charge":98.59,"discounted_cash":59.15,"setting":"both","billing_class":"facility"}]},{"description":"Pathology Billing Pap Smear, Automa","code_information":[{"code":"986083","type":"CDM"},{"code":"311","type":"RC"},{"code":"88148","type":"CPT"}],"standard_charges":[{"gross_charge":74.52,"discounted_cash":44.71,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Gyn Cytology with","code_information":[{"code":"986084","type":"CDM"},{"code":"311","type":"RC"},{"code":"88164","type":"CPT"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":31.64,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Gyn Cytology Sure","code_information":[{"code":"986085","type":"CDM"},{"code":"311","type":"RC"},{"code":"88142","type":"CPT"}],"standard_charges":[{"gross_charge":88.28,"discounted_cash":52.97,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Pap Smear, Automa","code_information":[{"code":"986087","type":"CDM"},{"code":"311","type":"RC"},{"code":"88147","type":"CPT"}],"standard_charges":[{"gross_charge":145.59,"discounted_cash":87.35,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Pap Smear, Liquid","code_information":[{"code":"986088","type":"CDM"},{"code":"311","type":"RC"},{"code":"88174","type":"CPT"}],"standard_charges":[{"gross_charge":76.81,"discounted_cash":46.09,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Pap Smear, Liquid","code_information":[{"code":"986089","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"CPT"}],"standard_charges":[{"gross_charge":124.95,"discounted_cash":74.97,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CDSM - NDSC","code_information":[{"code":"98765432","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.006,"setting":"both","billing_class":"facility"}]},{"description":"Pathology Billing Non-Gyn Cytology","code_information":[{"code":"989011","type":"CDM"},{"code":"311","type":"RC"},{"code":"88160","type":"CPT"}],"standard_charges":[{"gross_charge":162.78,"discounted_cash":97.67,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing FNA Interp and Re","code_information":[{"code":"989021","type":"CDM"},{"code":"311","type":"RC"},{"code":"88173","type":"CPT"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":142.14,"setting":"both","modifier_code":["90"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 90: Reference (Outside) Laboratory"}]},{"description":"Pathology Billing FNA Immediate Rea","code_information":[{"code":"989022","type":"CDM"},{"code":"311","type":"RC"},{"code":"88172","type":"CPT"}],"standard_charges":[{"gross_charge":405.82,"discounted_cash":243.49,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Pathology Billing Non-Gyn Cytology","code_information":[{"code":"989025","type":"CDM"},{"code":"311","type":"RC"},{"code":"88104","type":"CPT"}],"standard_charges":[{"gross_charge":136.42,"discounted_cash":81.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"SNF Laundry","code_information":[{"code":"990070050","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":50.92,"discounted_cash":30.55,"setting":"both","billing_class":"facility"}]},{"description":"Set & Style","code_information":[{"code":"990470061","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":12.10,"setting":"both","billing_class":"facility"}]},{"description":"Shampoo & Blow Dry","code_information":[{"code":"990470067","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":31.83,"discounted_cash":19.10,"setting":"both","billing_class":"facility"}]},{"description":"Hair 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Only","code_information":[{"code":"990700059","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":6.37,"setting":"both","billing_class":"facility"}]},{"description":"Manicure","code_information":[{"code":"990700060","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":8.27,"setting":"both","billing_class":"facility"}]},{"description":"Conditioner / Rinse","code_information":[{"code":"990700062","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility"}]},{"description":"Facial Hair Trim","code_information":[{"code":"990700064","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":8.27,"setting":"both","billing_class":"facility"}]},{"description":"Other Ancillary","code_information":[{"code":"990700099","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility"}]},{"description":"Hep b ig im","code_information":[{"code":"90371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.84,"maximum":323.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.95,"additional_payer_notes":"APC"},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161.38},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113.84},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":323.0},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":212.28,"additional_payer_notes":"APC"}]}]},{"description":"Rh ig full-dose im","code_information":[{"code":"90384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.26,"maximum":98.19,"payers_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.19},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69.26}]}]},{"description":"Dengue vacc quad 3 dose subq","code_information":[{"code":"90587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.59,"maximum":75.97,"payers_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.97},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53.59}]}]},{"description":"Menb-4c&menacwy vacc im","code_information":[{"code":"90624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.76,"maximum":305.88,"payers_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":305.88},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":215.76}]}]},{"description":"Hib prp-omp vacc 3 dose im","code_information":[{"code":"90647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.55,"maximum":36.22,"payers_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.22},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25.55}]}]},{"description":"Iiv3 vaccine splt 0.25 ml im","code_information":[{"code":"90657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.96,"maximum":12.7,"payers_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12.7},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8.96}]}]},{"description":"Riv3 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cm","code_information":[{"code":"Q4423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.06,"maximum":299.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":299.85},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":295.14,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.09,"additional_payer_notes":"APC"}]}]},{"description":"510(k) skin subs, nos","code_information":[{"code":"Q4432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.06,"maximum":299.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":299.85},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":295.14,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.09,"additional_payer_notes":"APC"}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":152.2,"10th_percentile":152.2,"90th_percentile":152.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":7.98,"10th_percentile":7.98,"90th_percentile":7.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":148.64,"10th_percentile":148.64,"90th_percentile":148.64,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1030.05,"10th_percentile":117.6,"90th_percentile":1722.0,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.14,"10th_percentile":110.14,"90th_percentile":110.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"23","median_amount":901.44,"10th_percentile":117.6,"90th_percentile":1804.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":117.6,"10th_percentile":117.6,"90th_percentile":117.6,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":65.05,"10th_percentile":62.21,"90th_percentile":1762.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":630.2,"10th_percentile":630.2,"90th_percentile":630.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":1030.05,"10th_percentile":1030.05,"90th_percentile":1030.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.88,"10th_percentile":111.88,"90th_percentile":111.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"14","median_amount":288.42,"10th_percentile":47.04,"90th_percentile":814.38},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":54.51,"10th_percentile":54.51,"90th_percentile":54.51,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.88,"10th_percentile":111.88,"90th_percentile":111.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":173.41,"10th_percentile":173.41,"90th_percentile":173.41,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.64,"10th_percentile":109.64,"90th_percentile":109.64,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":42.4,"10th_percentile":42.4,"90th_percentile":360.52},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":110.93,"10th_percentile":43.29,"90th_percentile":1030.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.88,"10th_percentile":111.88,"90th_percentile":111.88,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":371.95,"10th_percentile":371.95,"90th_percentile":371.95,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"14","median_amount":2382.6,"10th_percentile":1977.4,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":202.76,"10th_percentile":202.76,"90th_percentile":202.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":4599.0,"10th_percentile":4599.0,"90th_percentile":4599.0},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"46","median_amount":1977.15,"10th_percentile":988.58,"90th_percentile":3596.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":916.41,"10th_percentile":916.41,"90th_percentile":1099.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":2036.46,"10th_percentile":2036.46,"90th_percentile":2036.46,"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":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":1276.37,"10th_percentile":205.05,"90th_percentile":2539.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.99,"10th_percentile":199.69,"90th_percentile":201.08,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1251.56,"10th_percentile":1148.72,"90th_percentile":4546.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":731.55,"10th_percentile":731.55,"90th_percentile":731.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":2066.16,"10th_percentile":1977.15,"90th_percentile":4342.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":201.08,"10th_percentile":201.08,"90th_percentile":201.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":1730.99,"10th_percentile":1298.44,"90th_percentile":3861.42,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"25","median_amount":814.58,"10th_percentile":531.31,"90th_percentile":1579.1},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":34.97,"10th_percentile":34.97,"90th_percentile":1977.15,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":204.35,"10th_percentile":201.21,"90th_percentile":2678.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":312.42,"10th_percentile":312.42,"90th_percentile":312.42,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":201.08,"10th_percentile":201.08,"90th_percentile":201.08,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"17","median_amount":752.03,"10th_percentile":204.35,"90th_percentile":1548.77},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"26","median_amount":1018.23,"10th_percentile":676.78,"90th_percentile":3829.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":200.43,"10th_percentile":198.49,"90th_percentile":976.16,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":742.37,"10th_percentile":713.95,"90th_percentile":1519.4,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"105","median_amount":2790.0,"10th_percentile":2510.0,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"34","median_amount":403.96,"10th_percentile":345.78,"90th_percentile":647.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"15","median_amount":2790.0,"10th_percentile":1566.44,"90th_percentile":2790.0},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"319","median_amount":3279.94,"10th_percentile":1632.24,"90th_percentile":4508.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":2141.27,"10th_percentile":2141.27,"90th_percentile":2141.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":352.17,"10th_percentile":345.78,"90th_percentile":602.21,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":4273.58,"10th_percentile":2880.0,"90th_percentile":4408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"50","median_amount":2174.03,"10th_percentile":206.91,"90th_percentile":6258.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":596.7,"10th_percentile":347.28,"90th_percentile":1479.49,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"92","median_amount":2540.86,"10th_percentile":584.98,"90th_percentile":4956.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":2790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":341.74,"10th_percentile":341.74,"90th_percentile":341.74,"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":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"53","median_amount":4191.6,"10th_percentile":2982.0,"90th_percentile":6020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":1385.3,"10th_percentile":1385.3,"90th_percentile":1385.3},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":462.51,"10th_percentile":462.51,"90th_percentile":462.51,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":350.79,"10th_percentile":346.19,"90th_percentile":640.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"42","median_amount":2989.27,"10th_percentile":1929.37,"90th_percentile":6042.92,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"125","median_amount":1483.02,"10th_percentile":926.87,"90th_percentile":2543.52},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"28","median_amount":141.09,"10th_percentile":63.97,"90th_percentile":741.67,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":351.82,"10th_percentile":351.82,"90th_percentile":660.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":545.32,"10th_percentile":545.32,"90th_percentile":1051.14,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":346.78,"10th_percentile":346.19,"90th_percentile":596.2,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":398.3,"10th_percentile":398.3,"90th_percentile":698.2,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"53","median_amount":1112.53,"10th_percentile":351.82,"90th_percentile":3096.29},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":485.77,"10th_percentile":351.82,"90th_percentile":637.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"77","median_amount":1597.43,"10th_percentile":1097.67,"90th_percentile":3582.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"90","median_amount":351.16,"10th_percentile":344.78,"90th_percentile":1467.95,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"36","median_amount":1666.24,"10th_percentile":1131.22,"90th_percentile":3775.81,"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 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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"204","median_amount":2790.0,"10th_percentile":2510.0,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"75","median_amount":812.67,"10th_percentile":533.02,"90th_percentile":1297.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":2790.0,"10th_percentile":718.0,"90th_percentile":5449.45},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":2510.0,"10th_percentile":2510.0,"90th_percentile":2510.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"500","median_amount":4308.0,"10th_percentile":2037.14,"90th_percentile":5043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10394.56,"10th_percentile":5021.93,"90th_percentile":25206.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":842.36,"10th_percentile":641.67,"90th_percentile":1210.28,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"12","median_amount":3056.0,"10th_percentile":3046.4,"90th_percentile":4643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"68","median_amount":6071.94,"10th_percentile":1443.18,"90th_percentile":9718.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":969.21,"10th_percentile":656.09,"90th_percentile":1817.83,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"155","median_amount":6744.4,"10th_percentile":2148.49,"90th_percentile":10774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1976.38,"10th_percentile":1976.38,"90th_percentile":1976.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1163.15,"10th_percentile":1163.15,"90th_percentile":1420.15,"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":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"87","median_amount":6020.0,"10th_percentile":5742.0,"90th_percentile":6020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":6020.0,"10th_percentile":5742.0,"90th_percentile":6020.0},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1210.67,"10th_percentile":1037.47,"90th_percentile":10243.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":922.12,"10th_percentile":642.48,"90th_percentile":1429.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"58","median_amount":7743.0,"10th_percentile":4247.63,"90th_percentile":13737.2,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":21987.1,"10th_percentile":21987.1,"90th_percentile":21987.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"210","median_amount":3548.35,"10th_percentile":1438.81,"90th_percentile":8776.78},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"31","median_amount":333.45,"10th_percentile":123.89,"90th_percentile":867.36,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":848.59,"10th_percentile":541.05,"90th_percentile":1361.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":1315.84,"10th_percentile":350.0,"90th_percentile":2139.44,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":812.03,"10th_percentile":479.15,"90th_percentile":1336.58,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.32,"10th_percentile":763.85,"90th_percentile":1557.32,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"139","median_amount":2885.25,"10th_percentile":666.93,"90th_percentile":8484.34},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":976.72,"10th_percentile":774.09,"90th_percentile":1239.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"151","median_amount":4393.28,"10th_percentile":2365.15,"90th_percentile":9627.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"190","median_amount":834.02,"10th_percentile":533.03,"90th_percentile":1465.57,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"32","median_amount":4944.29,"10th_percentile":2830.52,"90th_percentile":8093.33,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"90","median_amount":2790.0,"10th_percentile":2253.29,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"54","median_amount":1155.47,"10th_percentile":642.37,"90th_percentile":1855.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"11","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":11252.22},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":10102.06,"10th_percentile":10102.06,"90th_percentile":10102.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"256","median_amount":4358.0,"10th_percentile":2286.4,"90th_percentile":5043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6002.64,"10th_percentile":6002.64,"90th_percentile":6002.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1189.01,"10th_percentile":764.42,"90th_percentile":1851.58,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":3430.0,"10th_percentile":3430.0,"90th_percentile":4508.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"60","median_amount":6460.72,"10th_percentile":420.91,"90th_percentile":9718.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":1286.78,"10th_percentile":874.06,"90th_percentile":3106.32,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"96","median_amount":7396.25,"10th_percentile":1566.45,"90th_percentile":11356.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1077.99,"10th_percentile":1077.99,"90th_percentile":1077.99,"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":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"45","median_amount":6020.0,"10th_percentile":5742.0,"90th_percentile":6084.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":6020.0,"10th_percentile":6020.0,"90th_percentile":6020.0},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1417.66,"10th_percentile":1417.66,"90th_percentile":1417.66,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":1142.47,"10th_percentile":875.71,"90th_percentile":2209.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"27","median_amount":7743.0,"10th_percentile":1145.63,"90th_percentile":16464.96,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":304.68,"10th_percentile":304.68,"90th_percentile":304.68,"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":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"165","median_amount":4181.3,"10th_percentile":1842.15,"90th_percentile":9527.26},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"25","median_amount":486.44,"10th_percentile":232.15,"90th_percentile":796.86,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"239","median_amount":1293.7,"10th_percentile":890.88,"90th_percentile":1893.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1622.39,"10th_percentile":1416.89,"90th_percentile":2402.95,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":1122.72,"10th_percentile":532.39,"90th_percentile":3405.21,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1758.91,"10th_percentile":1389.4,"90th_percentile":3791.46,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"83","median_amount":3604.5,"10th_percentile":1033.51,"90th_percentile":8795.18},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":1283.14,"10th_percentile":899.55,"90th_percentile":1765.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"92","median_amount":4041.28,"10th_percentile":1834.59,"90th_percentile":10419.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"200","median_amount":1174.06,"10th_percentile":873.07,"90th_percentile":2753.63,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"30","median_amount":3546.92,"10th_percentile":3102.47,"90th_percentile":12557.09,"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":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"15","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":18248.35,"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 ($): FEE SCHEDULE]","count":"17","median_amount":2422.97,"10th_percentile":1625.57,"90th_percentile":3897.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"39","median_amount":4358.0,"10th_percentile":2506.0,"90th_percentile":11244.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1534.23,"10th_percentile":1329.21,"90th_percentile":2079.92,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":9718.0,"10th_percentile":8092.0,"90th_percentile":10774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1918.61,"10th_percentile":1541.39,"90th_percentile":3553.96,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":10774.0,"10th_percentile":2639.75,"90th_percentile":37482.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"30","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1583.65,"10th_percentile":1583.65,"90th_percentile":1583.65,"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":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"14","median_amount":6020.0,"10th_percentile":5742.0,"90th_percentile":9821.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":5742.0,"10th_percentile":5742.0,"90th_percentile":5742.0},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"44","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1313.76,"10th_percentile":1228.22,"90th_percentile":3513.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":7743.0,"10th_percentile":7743.0,"90th_percentile":20490.53,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"58","median_amount":8450.56,"10th_percentile":3578.93,"90th_percentile":15849.42},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":563.48,"10th_percentile":476.15,"90th_percentile":887.62,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"134","median_amount":1877.99,"10th_percentile":1355.93,"90th_percentile":2588.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3099.7,"10th_percentile":3099.7,"90th_percentile":3099.7,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"20","median_amount":7993.82,"10th_percentile":1970.39,"90th_percentile":20606.24},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":2020.46,"10th_percentile":1451.34,"90th_percentile":5576.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"17","median_amount":9677.29,"10th_percentile":1369.02,"90th_percentile":17779.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"54","median_amount":1840.58,"10th_percentile":1348.99,"90th_percentile":3499.23,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":11751.32,"10th_percentile":7803.38,"90th_percentile":12227.38,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"51","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"145","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":66.09,"10th_percentile":66.09,"90th_percentile":66.09,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":214.01,"10th_percentile":214.01,"90th_percentile":214.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.42,"10th_percentile":446.42,"90th_percentile":446.42,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":7346.96,"10th_percentile":7346.96,"90th_percentile":7346.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":4333.81,"10th_percentile":4333.81,"90th_percentile":5092.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"17","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":450.25,"10th_percentile":450.25,"90th_percentile":450.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":2850.71,"10th_percentile":2850.71,"90th_percentile":2850.71},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":400.69,"10th_percentile":400.69,"90th_percentile":400.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":4433.92,"10th_percentile":4433.92,"90th_percentile":4433.92},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":2119.99,"10th_percentile":2119.99,"90th_percentile":2506.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":497.49,"10th_percentile":497.49,"90th_percentile":497.49,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":1551.92,"10th_percentile":1551.92,"90th_percentile":1551.92,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3984.21,"10th_percentile":3984.21,"90th_percentile":3984.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":22043.2,"10th_percentile":22043.2,"90th_percentile":22043.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":12121.8,"10th_percentile":12121.8,"90th_percentile":12121.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2030.32,"10th_percentile":982.95,"90th_percentile":2059.16,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":876.9,"10th_percentile":876.9,"90th_percentile":1121.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":3578.53,"10th_percentile":2803.15,"90th_percentile":11258.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":876.1,"10th_percentile":876.1,"90th_percentile":876.1,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1728.79,"10th_percentile":1728.79,"90th_percentile":1728.79,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3296.61,"10th_percentile":1357.0,"90th_percentile":3786.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":2411.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"23","median_amount":493.24,"10th_percentile":40.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":1007.28,"10th_percentile":1007.28,"90th_percentile":1007.28,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":2063.05,"10th_percentile":2063.05,"90th_percentile":2063.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":981.53,"10th_percentile":981.53,"90th_percentile":981.53,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2824.1,"10th_percentile":1349.23,"90th_percentile":9187.81,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2367.48,"10th_percentile":2367.48,"90th_percentile":2367.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":7793.37,"10th_percentile":6184.41,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":8911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":2867.12,"10th_percentile":2372.7,"90th_percentile":10076.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2069.45,"10th_percentile":2069.45,"90th_percentile":2069.45,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3644.2,"10th_percentile":3612.08,"90th_percentile":10615.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":11118.53,"10th_percentile":7292.78,"90th_percentile":13511.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":4487.86,"10th_percentile":4487.86,"90th_percentile":4487.86},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"43","median_amount":484.0,"10th_percentile":47.52,"90th_percentile":1154.44,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2025.74,"10th_percentile":2025.74,"90th_percentile":2025.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":5042.32,"10th_percentile":5042.32,"90th_percentile":5042.32,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2058.68,"10th_percentile":2058.68,"90th_percentile":2058.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":214.25,"10th_percentile":214.25,"90th_percentile":214.25,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":4320.2,"10th_percentile":3098.91,"90th_percentile":13255.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4287.49,"10th_percentile":4287.49,"90th_percentile":5056.61,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":2847.84,"10th_percentile":2847.84,"90th_percentile":2847.84,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":5918.73,"10th_percentile":5918.73,"90th_percentile":5918.73,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3563.79,"10th_percentile":3563.79,"90th_percentile":3563.79,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":14853.49,"10th_percentile":14853.49,"90th_percentile":14853.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"17","median_amount":579.87,"10th_percentile":475.52,"90th_percentile":1013.23,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3563.79,"10th_percentile":3563.79,"90th_percentile":3563.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":675.5,"10th_percentile":675.5,"90th_percentile":675.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3564.34,"10th_percentile":3564.34,"90th_percentile":3564.34,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":11176.23,"10th_percentile":11176.23,"90th_percentile":11176.23,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5368.35,"10th_percentile":5368.35,"90th_percentile":5368.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":14090.22,"10th_percentile":14090.22,"90th_percentile":14090.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1746.9,"10th_percentile":585.61,"90th_percentile":2410.14,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":33107.06,"10th_percentile":33107.06,"90th_percentile":33107.06,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":17447.09,"10th_percentile":17447.09,"90th_percentile":17447.09,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13187.93,"10th_percentile":13187.93,"90th_percentile":13187.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8014.73,"10th_percentile":8014.73,"90th_percentile":8014.73,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8344.61,"10th_percentile":8344.61,"90th_percentile":8344.61,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":8685.05,"10th_percentile":8685.05,"90th_percentile":8685.05,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":24041.98,"10th_percentile":24041.98,"90th_percentile":24041.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":39138.09,"10th_percentile":39138.09,"90th_percentile":39138.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21752.64,"10th_percentile":21752.64,"90th_percentile":21752.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"11","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"49","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"11","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":168.42,"10th_percentile":168.42,"90th_percentile":168.42,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1995.61,"10th_percentile":1995.61,"90th_percentile":2263.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":10164.81,"10th_percentile":5043.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1992.81,"10th_percentile":1992.81,"90th_percentile":1992.81,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":10243.0,"10th_percentile":10243.0,"90th_percentile":10243.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":10774.0,"10th_percentile":10774.0,"90th_percentile":10774.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":6020.0,"10th_percentile":5742.0,"90th_percentile":6020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"14","median_amount":814.49,"10th_percentile":518.46,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2000.94,"10th_percentile":2000.94,"90th_percentile":2000.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":14773.9,"10th_percentile":14773.9,"90th_percentile":14773.9},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":242.09,"10th_percentile":242.09,"90th_percentile":242.09,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2008.09,"10th_percentile":2008.09,"90th_percentile":2008.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1967.93,"10th_percentile":1967.93,"90th_percentile":1967.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1993.82,"10th_percentile":1992.81,"90th_percentile":1995.32,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":9435.86,"10th_percentile":8061.75,"90th_percentile":19513.61,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4048.65,"10th_percentile":425.0,"90th_percentile":8904.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":20781.66,"10th_percentile":20781.66,"90th_percentile":20781.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":25566.11,"10th_percentile":25566.11,"90th_percentile":25566.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":28274.98,"10th_percentile":28274.98,"90th_percentile":28274.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"58","median_amount":625.0,"10th_percentile":540.26,"90th_percentile":1000.24,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4056.64,"10th_percentile":4056.64,"90th_percentile":4056.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":10803.14,"10th_percentile":10803.14,"90th_percentile":10803.14,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1008.21,"10th_percentile":1008.21,"90th_percentile":1008.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4061.29,"10th_percentile":4061.29,"90th_percentile":4061.29,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":8527.06,"10th_percentile":8527.06,"90th_percentile":8527.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":11524.37,"10th_percentile":7709.5,"90th_percentile":13327.53,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8902.28,"10th_percentile":425.0,"90th_percentile":10074.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":10327.26,"90th_percentile":57013.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8867.71,"10th_percentile":8867.71,"90th_percentile":8867.71,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":23094.19,"10th_percentile":23094.19,"90th_percentile":23094.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8901.75,"10th_percentile":8901.75,"90th_percentile":8901.75,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":27122.43,"10th_percentile":25538.15,"90th_percentile":29065.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"61","median_amount":719.71,"10th_percentile":438.83,"90th_percentile":1007.41,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9146.79,"10th_percentile":9146.79,"90th_percentile":9146.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":23866.25,"10th_percentile":20219.83,"90th_percentile":49832.75,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2657.88,"10th_percentile":2657.88,"90th_percentile":2657.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13854.72,"10th_percentile":13854.72,"90th_percentile":13854.72,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":1036.29,"10th_percentile":1036.29,"90th_percentile":1036.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2.33,"10th_percentile":2.33,"90th_percentile":2.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":29357.75,"10th_percentile":29357.75,"90th_percentile":29357.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8895.29,"10th_percentile":8895.29,"90th_percentile":8895.29,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":17546.76,"10th_percentile":17546.76,"90th_percentile":17546.76,"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 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":19085.68,"10th_percentile":330.6,"90th_percentile":20373.77,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16216.18,"10th_percentile":16208.56,"90th_percentile":18533.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"14","median_amount":12899.0,"10th_percentile":10765.6,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16238.86,"10th_percentile":16238.86,"90th_percentile":16539.7,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":22401.2,"10th_percentile":5850.84,"90th_percentile":26242.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16213.77,"10th_percentile":16208.56,"90th_percentile":16240.61,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":21981.6,"10th_percentile":2470.96,"90th_percentile":28046.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":50072.62,"10th_percentile":50072.62,"90th_percentile":50072.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"68","median_amount":1010.44,"10th_percentile":781.85,"90th_percentile":5431.83,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16302.2,"10th_percentile":16302.2,"90th_percentile":16302.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":34071.45,"10th_percentile":34071.45,"90th_percentile":47614.94,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1708.44,"10th_percentile":1708.44,"90th_percentile":1708.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":32217.46,"10th_percentile":29629.85,"90th_percentile":35465.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":16309.0,"10th_percentile":16212.7,"90th_percentile":16539.35,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":23071.01,"10th_percentile":23071.01,"90th_percentile":24942.43,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":25815.29,"10th_percentile":25815.29,"90th_percentile":25815.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1023.92,"10th_percentile":1023.92,"90th_percentile":1023.92,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23207.74,"10th_percentile":23207.74,"90th_percentile":23207.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22899.08,"10th_percentile":14003.79,"90th_percentile":23367.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.73,"10th_percentile":333.73,"90th_percentile":333.73,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":60.02,"10th_percentile":60.02,"90th_percentile":60.02,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2066.47,"10th_percentile":2066.47,"90th_percentile":2066.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2156.05,"10th_percentile":2156.05,"90th_percentile":2156.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":7832.4,"10th_percentile":7832.4,"90th_percentile":7832.4,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":529.03,"10th_percentile":486.5,"90th_percentile":588.27,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10176.39,"10th_percentile":10176.39,"90th_percentile":10176.39,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":13349.24,"10th_percentile":13349.24,"90th_percentile":13349.24,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13215.23,"10th_percentile":13215.23,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8654.96,"10th_percentile":8654.96,"90th_percentile":8654.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":726.89,"10th_percentile":726.89,"90th_percentile":726.89,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":12860.8,"10th_percentile":12860.8,"90th_percentile":12860.8,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":12595.07,"10th_percentile":12595.07,"90th_percentile":16623.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"14","median_amount":532.19,"10th_percentile":494.8,"90th_percentile":628.53,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4054.71,"10th_percentile":4054.71,"90th_percentile":4054.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":25436.88,"10th_percentile":25436.88,"90th_percentile":25436.88,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":19352.65,"10th_percentile":19352.65,"90th_percentile":39865.66,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7373.11,"10th_percentile":7373.11,"90th_percentile":7373.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12015.95,"90th_percentile":36970.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8692.89,"10th_percentile":8692.89,"90th_percentile":8692.89,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":30500.44,"10th_percentile":30500.44,"90th_percentile":30500.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":44090.08,"10th_percentile":44090.08,"90th_percentile":44090.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":618.41,"10th_percentile":553.29,"90th_percentile":789.94,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7366.11,"10th_percentile":7366.11,"90th_percentile":7366.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":27027.41,"10th_percentile":27027.41,"90th_percentile":27027.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7424.45,"10th_percentile":7424.45,"90th_percentile":7424.45,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":2422.56,"10th_percentile":2422.56,"90th_percentile":2422.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":3344.39,"10th_percentile":3344.39,"90th_percentile":3344.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":879.49,"10th_percentile":879.49,"90th_percentile":879.49,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1568.64,"10th_percentile":1568.64,"90th_percentile":1568.64,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1460.29,"10th_percentile":1460.29,"90th_percentile":1460.29,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1536.86,"10th_percentile":1536.86,"90th_percentile":1536.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1941.0,"10th_percentile":1941.0,"90th_percentile":2041.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":6842.73,"10th_percentile":6842.73,"90th_percentile":6842.73,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3935.22,"10th_percentile":3935.22,"90th_percentile":3935.22,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":5826.84,"10th_percentile":5826.84,"90th_percentile":5826.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":574.18,"10th_percentile":560.12,"90th_percentile":696.84,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3935.22,"10th_percentile":3935.22,"90th_percentile":3935.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7214.89,"10th_percentile":7214.89,"90th_percentile":7214.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3905.13,"10th_percentile":3905.13,"90th_percentile":3935.22,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3919.23,"10th_percentile":3919.23,"90th_percentile":3919.23,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6738.11,"10th_percentile":6738.11,"90th_percentile":6738.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":9327.2,"10th_percentile":9327.2,"90th_percentile":9327.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6758.58,"10th_percentile":6758.58,"90th_percentile":6758.58,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":715.39,"10th_percentile":615.77,"90th_percentile":828.59,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6758.58,"10th_percentile":6758.58,"90th_percentile":6758.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":1081.24,"10th_percentile":1081.24,"90th_percentile":2834.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12659.0,"10th_percentile":12659.0,"90th_percentile":12659.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":18962.63,"10th_percentile":18962.63,"90th_percentile":18962.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22359.5,"10th_percentile":22359.5,"90th_percentile":22359.5,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13031.3,"10th_percentile":13031.3,"90th_percentile":13031.3,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":4258.0,"10th_percentile":4208.0,"90th_percentile":4258.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":10607.0,"10th_percentile":10607.0,"90th_percentile":10607.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":6020.0,"10th_percentile":6020.0,"90th_percentile":6020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"13","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2706.09,"10th_percentile":2706.09,"90th_percentile":2706.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":6788.33,"10th_percentile":6788.33,"90th_percentile":6788.33,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12809.0,"10th_percentile":12809.0,"90th_percentile":13507.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":2612.71,"10th_percentile":2612.71,"90th_percentile":2612.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1738.6,"10th_percentile":1738.6,"90th_percentile":1738.6,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1733.12,"10th_percentile":1733.12,"90th_percentile":1733.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1398.56,"10th_percentile":1129.3,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"32","median_amount":134.15,"10th_percentile":36.35,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1902.85,"10th_percentile":1902.85,"90th_percentile":1902.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":46691.98,"10th_percentile":46691.98,"90th_percentile":49230.05},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1172.2,"10th_percentile":1114.47,"90th_percentile":1172.2,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":8603.95,"10th_percentile":8603.95,"90th_percentile":8603.95},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":1221.01,"10th_percentile":1221.01,"90th_percentile":2136.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1898.42,"10th_percentile":1898.42,"90th_percentile":2748.56,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":2593.21,"10th_percentile":2593.21,"90th_percentile":2593.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":488.42,"10th_percentile":488.42,"90th_percentile":546.86,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":33492.73,"10th_percentile":33492.73,"90th_percentile":33492.73,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3445.73,"10th_percentile":3445.73,"90th_percentile":3445.73},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":873.33,"10th_percentile":873.33,"90th_percentile":873.33,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":9682.2,"10th_percentile":9682.2,"90th_percentile":9682.2,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":6714.0,"10th_percentile":6714.0,"90th_percentile":6714.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":2428.28,"10th_percentile":2428.28,"90th_percentile":2428.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":599.08,"10th_percentile":599.08,"90th_percentile":599.08,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":2432.44,"10th_percentile":2432.44,"90th_percentile":2432.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":3297.95,"10th_percentile":3297.95,"90th_percentile":3297.95,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":7901.14,"10th_percentile":7737.99,"90th_percentile":8625.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":2483.05,"10th_percentile":2483.05,"90th_percentile":2483.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":2379.65,"10th_percentile":2379.65,"90th_percentile":2379.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":4032.96,"10th_percentile":4032.96,"90th_percentile":4032.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":555.78,"10th_percentile":502.86,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":7952.58,"10th_percentile":7952.58,"90th_percentile":7952.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2167.41,"10th_percentile":1468.18,"90th_percentile":2785.99,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":5948.93,"10th_percentile":5948.93,"90th_percentile":5948.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":11835.93,"10th_percentile":11835.93,"90th_percentile":11835.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":488.8,"10th_percentile":443.12,"90th_percentile":510.61,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34289.45,"10th_percentile":34289.45,"90th_percentile":34289.45,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":18828.32,"10th_percentile":18828.32,"90th_percentile":18828.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":695.72,"10th_percentile":537.69,"90th_percentile":1412.97,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4253.46,"10th_percentile":4253.46,"90th_percentile":4253.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4412.28,"10th_percentile":4412.28,"90th_percentile":4412.28,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4394.34,"10th_percentile":4394.34,"90th_percentile":4394.34,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":10718.15,"10th_percentile":10718.15,"90th_percentile":10718.15,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1648.37,"10th_percentile":1648.37,"90th_percentile":1648.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":748.05,"10th_percentile":744.66,"90th_percentile":806.71,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":9844.81,"10th_percentile":2087.7,"90th_percentile":14446.54,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7273.38,"10th_percentile":7273.38,"90th_percentile":7273.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":15731.18,"10th_percentile":15731.18,"90th_percentile":15731.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"32","median_amount":12909.0,"10th_percentile":8544.9,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7294.53,"10th_percentile":7294.53,"90th_percentile":7294.53,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":3402.3,"10th_percentile":3402.3,"90th_percentile":3402.3,"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":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":725.8,"10th_percentile":725.8,"90th_percentile":725.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7268.88,"10th_percentile":7268.88,"90th_percentile":7268.88,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"11","median_amount":15406.89,"10th_percentile":3346.39,"90th_percentile":25020.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":20899.29,"10th_percentile":20899.29,"90th_percentile":27057.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"100","median_amount":803.73,"10th_percentile":708.47,"90th_percentile":1227.72,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7294.53,"10th_percentile":7294.53,"90th_percentile":7294.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":24207.41,"10th_percentile":21070.56,"90th_percentile":35855.24,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11490.37,"10th_percentile":11490.37,"90th_percentile":11490.37,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":750.0,"10th_percentile":750.0,"90th_percentile":1499.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":2757.9,"10th_percentile":2757.9,"90th_percentile":2757.9},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":13649.43,"10th_percentile":11995.33,"90th_percentile":21950.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7209.21,"10th_percentile":7071.03,"90th_percentile":23844.55,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":13812.47,"10th_percentile":13812.47,"90th_percentile":13812.47,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":31652.94,"10th_percentile":31652.94,"90th_percentile":31652.94,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":35876.02,"10th_percentile":35876.02,"90th_percentile":37780.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":42229.4,"10th_percentile":23260.05,"90th_percentile":124570.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":42968.54,"10th_percentile":42968.54,"90th_percentile":42968.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"15","median_amount":887.6,"10th_percentile":788.83,"90th_percentile":1091.93,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13016.84,"10th_percentile":13016.84,"90th_percentile":13016.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":25766.85,"10th_percentile":25766.85,"90th_percentile":25766.85,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":27964.28,"10th_percentile":27964.28,"90th_percentile":27964.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12973.3,"10th_percentile":12963.93,"90th_percentile":13230.0,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1652.33,"10th_percentile":1652.33,"90th_percentile":1652.33,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":2737.15,"10th_percentile":2737.15,"90th_percentile":2737.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":277.91,"10th_percentile":277.91,"90th_percentile":277.91,"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":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":2613.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":304.08,"10th_percentile":304.08,"90th_percentile":304.08,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":302.84,"10th_percentile":302.84,"90th_percentile":302.84,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":831.13,"10th_percentile":831.13,"90th_percentile":831.13,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":8360.67,"10th_percentile":8360.67,"90th_percentile":8360.67,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2553.58,"10th_percentile":2553.58,"90th_percentile":2553.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":12909.0,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":7006.19,"10th_percentile":7006.19,"90th_percentile":7006.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"11","median_amount":482.35,"10th_percentile":6.0,"90th_percentile":560.22,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":403.24,"10th_percentile":348.6,"90th_percentile":849.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2550.79,"10th_percentile":2550.79,"90th_percentile":2550.79,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":8019.9,"10th_percentile":8019.9,"90th_percentile":8019.9,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":3759.8,"10th_percentile":3759.8,"90th_percentile":8259.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6235.69,"10th_percentile":6214.89,"90th_percentile":6900.08,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":13436.46,"10th_percentile":13436.46,"90th_percentile":18844.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":3082.74,"10th_percentile":3082.74,"90th_percentile":3082.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":22122.41,"10th_percentile":22122.41,"90th_percentile":22122.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":836.58,"10th_percentile":627.92,"90th_percentile":1636.9,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":8347.84,"10th_percentile":8347.84,"90th_percentile":8347.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4294.62,"10th_percentile":4294.62,"90th_percentile":4294.62,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":9348.71,"10th_percentile":9348.71,"90th_percentile":9348.71,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12910.44,"10th_percentile":12156.3,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6330.06,"10th_percentile":6330.06,"90th_percentile":6330.06,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3021.93,"10th_percentile":3021.93,"90th_percentile":12769.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":27151.56,"10th_percentile":27151.56,"90th_percentile":27151.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"14","median_amount":680.38,"10th_percentile":548.76,"90th_percentile":835.87,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6355.9,"10th_percentile":6355.9,"90th_percentile":6355.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10020.77,"10th_percentile":10020.77,"90th_percentile":10020.77,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":792.77,"10th_percentile":792.77,"90th_percentile":792.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":15755.46,"10th_percentile":15755.46,"90th_percentile":15755.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6459.25,"10th_percentile":6335.71,"90th_percentile":6465.01,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":15743.36,"10th_percentile":15743.36,"90th_percentile":15743.36,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":15007.73,"10th_percentile":15007.73,"90th_percentile":15007.73,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":13707.0,"10th_percentile":13707.0,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":934.15,"10th_percentile":934.15,"90th_percentile":989.33,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":18184.84,"10th_percentile":18184.84,"90th_percentile":18184.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1828.21,"10th_percentile":1828.21,"90th_percentile":1828.21,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":2493.94,"10th_percentile":2493.94,"90th_percentile":2493.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":7717.89,"10th_percentile":7717.89,"90th_percentile":7717.89,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12909.0,"10th_percentile":9594.9,"90th_percentile":13707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":11495.41,"10th_percentile":11495.41,"90th_percentile":11495.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":8926.3,"10th_percentile":8563.99,"90th_percentile":9886.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":18468.99,"10th_percentile":10725.96,"90th_percentile":19906.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":12232.23,"10th_percentile":12232.23,"90th_percentile":12677.7,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6262.93,"10th_percentile":6262.93,"90th_percentile":6262.93,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":1584.04,"10th_percentile":1584.04,"90th_percentile":1584.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9233.64,"10th_percentile":9233.64,"90th_percentile":9233.64,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":13807.11,"10th_percentile":13807.11,"90th_percentile":13807.11,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6146.8,"10th_percentile":6146.8,"90th_percentile":6146.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":12703.29,"10th_percentile":12703.29,"90th_percentile":12703.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1090.23,"10th_percentile":1090.23,"90th_percentile":1090.23,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":15195.21,"10th_percentile":15195.21,"90th_percentile":15195.21,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":14327.62,"10th_percentile":14327.62,"90th_percentile":14327.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10591.13,"10th_percentile":10591.13,"90th_percentile":10591.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1019.87,"10th_percentile":1019.87,"90th_percentile":1019.87,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9207.93,"10th_percentile":9207.93,"90th_percentile":9207.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":5589.46,"10th_percentile":5589.46,"90th_percentile":5589.46,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2438.57,"10th_percentile":2438.57,"90th_percentile":2438.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":7599.55,"10th_percentile":7599.55,"90th_percentile":7599.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2431.57,"10th_percentile":2431.57,"90th_percentile":2431.57,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":608.22,"10th_percentile":495.95,"90th_percentile":825.15,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2441.49,"10th_percentile":2441.49,"90th_percentile":2441.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":11681.46,"10th_percentile":11681.46,"90th_percentile":11681.46,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":2412.38,"10th_percentile":2412.38,"90th_percentile":2412.38},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":8773.05,"10th_percentile":8773.05,"90th_percentile":8773.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":552.15,"10th_percentile":552.15,"90th_percentile":552.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":4993.0,"10th_percentile":4042.73,"90th_percentile":6580.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":713.64,"10th_percentile":713.64,"90th_percentile":713.64,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":2606.31,"10th_percentile":2606.31,"90th_percentile":2606.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":715.15,"10th_percentile":715.15,"90th_percentile":715.15,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1847.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":525.99,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":553.6,"10th_percentile":553.6,"90th_percentile":553.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":1923.87,"10th_percentile":1923.87,"90th_percentile":1923.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":439.75,"10th_percentile":439.75,"90th_percentile":439.95,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":1538.05,"10th_percentile":1538.05,"90th_percentile":1538.05,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1491.7,"10th_percentile":790.96,"90th_percentile":1510.13,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":872.13,"10th_percentile":871.73,"90th_percentile":874.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":1872.56,"10th_percentile":1872.56,"90th_percentile":1872.56},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":1530.21,"10th_percentile":1530.21,"90th_percentile":1530.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"53","median_amount":4016.3,"10th_percentile":3213.04,"90th_percentile":5042.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":871.73,"10th_percentile":871.73,"90th_percentile":871.77,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":4016.3,"10th_percentile":4016.3,"90th_percentile":4016.3,"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":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"14","median_amount":2172.81,"10th_percentile":2172.81,"90th_percentile":4086.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":2407.16,"10th_percentile":2304.98,"90th_percentile":2864.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1182.9,"10th_percentile":1182.9,"90th_percentile":1182.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":1990.42,"10th_percentile":1897.77,"90th_percentile":2012.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"90","median_amount":334.56,"10th_percentile":331.4,"90th_percentile":344.14,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":875.29,"10th_percentile":868.82,"90th_percentile":875.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":2598.55,"10th_percentile":2598.55,"90th_percentile":5052.49,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":246.75,"10th_percentile":246.75,"90th_percentile":246.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":4042.45,"10th_percentile":4042.45,"90th_percentile":4042.45},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3229.72,"10th_percentile":3229.72,"90th_percentile":3229.72,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":2249.42,"10th_percentile":2249.42,"90th_percentile":2249.42},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"11","median_amount":1478.39,"10th_percentile":1460.64,"90th_percentile":1478.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":871.74,"10th_percentile":846.76,"90th_percentile":875.3,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":1450.29,"10th_percentile":1450.29,"90th_percentile":1450.29,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":340.99,"10th_percentile":310.3,"90th_percentile":375.1,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":7.92,"10th_percentile":7.92,"90th_percentile":7.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":912.32,"10th_percentile":912.32,"90th_percentile":912.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":727.03,"10th_percentile":727.03,"90th_percentile":727.03,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27248.74,"10th_percentile":27248.74,"90th_percentile":27248.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2853.4,"10th_percentile":2853.4,"90th_percentile":2853.4,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":1890.91,"10th_percentile":1890.91,"90th_percentile":1890.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"15","median_amount":830.5,"10th_percentile":209.32,"90th_percentile":1128.34,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":110.44,"10th_percentile":110.44,"90th_percentile":253.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":2145.15,"10th_percentile":2145.15,"90th_percentile":2145.15},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"43","median_amount":825.0,"10th_percentile":109.64,"90th_percentile":876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.19,"10th_percentile":100.69,"90th_percentile":109.64,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":527.73,"10th_percentile":349.74,"90th_percentile":681.87,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"12","median_amount":1443.98,"10th_percentile":1106.02,"90th_percentile":1836.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"408","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"14","median_amount":1466.35,"10th_percentile":390.69,"90th_percentile":1770.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":1291.53,"10th_percentile":1291.53,"90th_percentile":1291.53},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1364","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.72,"10th_percentile":110.09,"90th_percentile":330.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":216.48,"10th_percentile":191.52,"90th_percentile":1990.56,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":225.12,"10th_percentile":225.12,"90th_percentile":225.12},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"17","median_amount":166.71,"10th_percentile":85.66,"90th_percentile":347.08,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":400.9,"10th_percentile":400.9,"90th_percentile":400.9,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":45.52,"10th_percentile":16.04,"90th_percentile":338.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.09,"10th_percentile":110.09,"90th_percentile":258.38,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"56","median_amount":195.48,"10th_percentile":24.09,"90th_percentile":232.78},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"12","median_amount":1047.02,"10th_percentile":179.72,"90th_percentile":1104.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"249","median_amount":36.4,"10th_percentile":17.85,"90th_percentile":232.78,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":897.5,"10th_percentile":316.22,"90th_percentile":1083.68,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"51","median_amount":758.31,"10th_percentile":123.62,"90th_percentile":1204.14,"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 ($): FEE SCHEDULE]","count":"54","median_amount":133.22,"10th_percentile":132.42,"90th_percentile":263.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":770.65,"10th_percentile":401.31,"90th_percentile":4417.35},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":121.61,"10th_percentile":121.61,"90th_percentile":121.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"117","median_amount":825.0,"10th_percentile":155.39,"90th_percentile":876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3599.96,"10th_percentile":3599.96,"90th_percentile":3599.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"92","median_amount":123.62,"10th_percentile":31.02,"90th_percentile":269.37,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":1495.77,"10th_percentile":1420.69,"90th_percentile":3438.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":263.99,"10th_percentile":132.42,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"71","median_amount":1525.74,"10th_percentile":167.62,"90th_percentile":2702.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"272","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"31","median_amount":1466.35,"10th_percentile":243.22,"90th_percentile":2290.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":814.64,"10th_percentile":814.64,"90th_percentile":814.64},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1291","median_amount":1000.0,"10th_percentile":131.96,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":132.96,"10th_percentile":132.96,"90th_percentile":135.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"38","median_amount":243.22,"10th_percentile":39.64,"90th_percentile":2858.03,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":800.0,"10th_percentile":800.0,"90th_percentile":800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":388.82,"10th_percentile":204.85,"90th_percentile":1047.62,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.88,"10th_percentile":418.88,"90th_percentile":418.88,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":192.14,"10th_percentile":192.14,"90th_percentile":2407.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.96,"10th_percentile":132.96,"90th_percentile":132.96,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"345","median_amount":123.62,"10th_percentile":31.02,"90th_percentile":243.22},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":121.61,"10th_percentile":121.61,"90th_percentile":121.61},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"49","median_amount":966.65,"10th_percentile":243.99,"90th_percentile":2296.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"823","median_amount":121.61,"10th_percentile":31.02,"90th_percentile":243.22,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"21","median_amount":948.31,"10th_percentile":257.43,"90th_percentile":1595.18,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2183.0,"10th_percentile":2183.0,"90th_percentile":3274.5,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":825.0,"10th_percentile":825.0,"90th_percentile":5043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.54,"10th_percentile":275.54,"90th_percentile":275.54,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":302.22,"10th_percentile":302.22,"90th_percentile":302.22,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3322.94,"10th_percentile":3322.94,"90th_percentile":3322.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"77","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":3567.56,"10th_percentile":3567.56,"90th_percentile":3567.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"252","median_amount":1000.0,"10th_percentile":744.64,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":302.22,"10th_percentile":302.22,"90th_percentile":302.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":352.08,"10th_percentile":352.08,"90th_percentile":352.08,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":2664.88,"10th_percentile":2664.88,"90th_percentile":2664.88},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":348.25,"10th_percentile":348.25,"90th_percentile":348.25,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":476.05,"10th_percentile":476.05,"90th_percentile":476.05,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":171.95,"10th_percentile":171.95,"90th_percentile":171.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"23","median_amount":276.42,"10th_percentile":275.54,"90th_percentile":617.82},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":2899.0,"10th_percentile":2899.0,"90th_percentile":5798.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":276.42,"10th_percentile":275.54,"90th_percentile":614.26,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2044.4,"10th_percentile":2044.4,"90th_percentile":2044.4,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":2603.0,"10th_percentile":2603.0,"90th_percentile":2603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1078.58,"10th_percentile":1078.58,"90th_percentile":1078.58,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":3327.05,"10th_percentile":3327.05,"90th_percentile":3327.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"23","median_amount":1000.0,"10th_percentile":163.5,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":750.0,"10th_percentile":750.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":815.04,"10th_percentile":815.04,"90th_percentile":815.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":689.28,"10th_percentile":627.0,"90th_percentile":2001.71,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":2001.83,"10th_percentile":2001.83,"90th_percentile":2001.83,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":280.67,"10th_percentile":280.67,"90th_percentile":280.67,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":407.03,"10th_percentile":407.03,"90th_percentile":415.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":4396.5,"10th_percentile":4396.5,"90th_percentile":4396.5},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"1 through 10","median_amount":164.58,"10th_percentile":164.58,"90th_percentile":164.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":1021.0,"10th_percentile":89.7,"90th_percentile":1482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":407.23,"10th_percentile":318.88,"90th_percentile":407.83,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":91.0,"10th_percentile":91.0,"90th_percentile":91.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":852.91,"10th_percentile":852.91,"90th_percentile":852.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.12,"10th_percentile":415.12,"90th_percentile":415.12,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1582.35,"10th_percentile":1582.35,"90th_percentile":1582.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"33","median_amount":1200.0,"10th_percentile":114.29,"90th_percentile":2432.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":1877.89,"10th_percentile":1877.89,"90th_percentile":1877.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"82","median_amount":1000.0,"10th_percentile":373.6,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":222.57,"10th_percentile":222.57,"90th_percentile":260.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":89.7,"10th_percentile":89.7,"90th_percentile":89.7,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":584.66,"10th_percentile":584.66,"90th_percentile":584.66,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":856.93,"10th_percentile":856.93,"90th_percentile":856.93,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":283.62,"10th_percentile":283.62,"90th_percentile":283.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"22","median_amount":270.32,"10th_percentile":78.0,"90th_percentile":300.36},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":912.46,"10th_percentile":473.08,"90th_percentile":950.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"100","median_amount":270.32,"10th_percentile":90.8,"90th_percentile":318.29,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":930.47,"10th_percentile":930.47,"90th_percentile":930.47,"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."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2183.0,"10th_percentile":2183.0,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":1575.0,"10th_percentile":805.59,"90th_percentile":6134.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":637.0,"10th_percentile":637.0,"90th_percentile":637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1963.89,"10th_percentile":1963.89,"90th_percentile":1963.89,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":7938.35,"10th_percentile":7938.35,"90th_percentile":7938.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"162","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":2929.87,"10th_percentile":2929.87,"90th_percentile":2929.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"472","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.51,"10th_percentile":446.51,"90th_percentile":1067.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":521.84,"10th_percentile":521.84,"90th_percentile":521.84,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":800.0,"10th_percentile":800.0,"90th_percentile":1100.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":2872.45,"10th_percentile":2872.45,"90th_percentile":2872.45},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":524.66,"10th_percentile":354.75,"90th_percentile":862.25,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":836.99,"10th_percentile":836.99,"90th_percentile":836.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1248.66,"10th_percentile":1248.66,"90th_percentile":1248.66,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":385.66,"10th_percentile":385.66,"90th_percentile":750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.51,"10th_percentile":446.51,"90th_percentile":446.51,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"15","median_amount":423.49,"10th_percentile":408.39,"90th_percentile":977.54},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":5417.6,"10th_percentile":4571.04,"90th_percentile":5504.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":438.21,"10th_percentile":408.39,"90th_percentile":1068.93,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":5688.0,"10th_percentile":5688.0,"90th_percentile":5688.0,"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":"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":540.54,"10th_percentile":540.54,"90th_percentile":540.54,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1703.96,"10th_percentile":1703.96,"90th_percentile":1703.96,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":1114.83,"10th_percentile":825.0,"90th_percentile":3396.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":602.77,"10th_percentile":602.77,"90th_percentile":602.77,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":2632.98,"10th_percentile":2632.98,"90th_percentile":2632.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1676.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":2465.92,"10th_percentile":2465.92,"90th_percentile":2465.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"12","median_amount":848.52,"10th_percentile":679.97,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":236.58,"10th_percentile":236.58,"90th_percentile":236.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":502.4,"10th_percentile":502.4,"90th_percentile":502.4,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":459.51,"10th_percentile":459.51,"90th_percentile":602.77},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":463.79,"10th_percentile":459.51,"90th_percentile":573.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1068.36,"10th_percentile":1000.0,"90th_percentile":1068.51,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":812.5,"10th_percentile":812.5,"90th_percentile":812.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":702.1,"10th_percentile":702.1,"90th_percentile":702.1,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":5967.64,"10th_percentile":5967.64,"90th_percentile":5967.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":647.07,"10th_percentile":647.07,"90th_percentile":647.07,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1774.15,"10th_percentile":1738.67,"90th_percentile":3193.48,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":293.0,"10th_percentile":293.0,"90th_percentile":293.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":56.4,"10th_percentile":56.4,"90th_percentile":56.4,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":372.09,"10th_percentile":372.09,"90th_percentile":372.09,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"17","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":371.59,"10th_percentile":371.59,"90th_percentile":371.59,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":293.0,"10th_percentile":293.0,"90th_percentile":293.0},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.0,"10th_percentile":240.96,"90th_percentile":293.0,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":825.0,"10th_percentile":825.0,"90th_percentile":825.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":515.85,"10th_percentile":439.36,"90th_percentile":944.96,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":356.6,"10th_percentile":356.6,"90th_percentile":356.6},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":356.6,"10th_percentile":354.11,"90th_percentile":2346.23,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":876.0,"10th_percentile":876.0,"90th_percentile":876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":852.58,"10th_percentile":852.58,"90th_percentile":852.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":30.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":634.44,"10th_percentile":634.44,"90th_percentile":634.44},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":634.44,"10th_percentile":634.44,"90th_percentile":634.44,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2588.42,"10th_percentile":2588.42,"90th_percentile":2588.42,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":3580.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":33521.06,"10th_percentile":33521.06,"90th_percentile":33521.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"14","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5530.97,"10th_percentile":5530.97,"90th_percentile":5530.97,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":2250.0,"10th_percentile":2250.0,"90th_percentile":2250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":10721.73,"10th_percentile":10721.73,"90th_percentile":10721.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"62","median_amount":1200.0,"10th_percentile":860.07,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"194","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":54.06,"10th_percentile":54.06,"90th_percentile":54.06,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12534.0,"10th_percentile":12534.0,"90th_percentile":12534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2615.41,"10th_percentile":2615.41,"90th_percentile":2615.41,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"229","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"644","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":7743.0,"10th_percentile":7743.0,"90th_percentile":7743.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":800.0,"10th_percentile":800.0,"90th_percentile":800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":800.0,"10th_percentile":800.0,"90th_percentile":800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"18","median_amount":601.18,"10th_percentile":180.96,"90th_percentile":930.61,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":750.0,"10th_percentile":750.0,"90th_percentile":1500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":1027.93,"10th_percentile":1027.93,"90th_percentile":1027.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":608.35,"10th_percentile":608.35,"90th_percentile":608.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":379.55,"10th_percentile":379.55,"90th_percentile":379.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":73.96,"10th_percentile":73.96,"90th_percentile":73.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":389.55,"10th_percentile":97.73,"90th_percentile":12909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":291.07,"10th_percentile":291.07,"90th_percentile":291.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":55.29,"10th_percentile":55.29,"90th_percentile":55.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"58","median_amount":1200.0,"10th_percentile":1051.69,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"118","median_amount":1000.0,"10th_percentile":528.66,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":74.26,"10th_percentile":74.26,"90th_percentile":74.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":203.92,"10th_percentile":117.76,"90th_percentile":480.76,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":38.82,"10th_percentile":38.82,"90th_percentile":70.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":74.26,"10th_percentile":74.26,"90th_percentile":74.26,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":68.78,"10th_percentile":68.78,"90th_percentile":68.78},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.59,"10th_percentile":102.59,"90th_percentile":102.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":73.97,"10th_percentile":68.78,"90th_percentile":93.68,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":133.34,"10th_percentile":133.34,"90th_percentile":133.34,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"21","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"78","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":414.96,"10th_percentile":414.96,"90th_percentile":414.96},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":151.51,"10th_percentile":151.51,"90th_percentile":151.51,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1136.44,"10th_percentile":1136.44,"90th_percentile":1136.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":12037.37,"10th_percentile":12037.37,"90th_percentile":12037.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":767.0,"10th_percentile":767.0,"90th_percentile":767.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.83,"10th_percentile":814.83,"90th_percentile":814.83,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8476.8,"10th_percentile":8476.8,"90th_percentile":8476.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":7657.9,"10th_percentile":7657.9,"90th_percentile":7657.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.84,"10th_percentile":814.84,"90th_percentile":8869.13,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"12","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, acetaminophen (hikma)","code_information":[{"code":"9282","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2138.96,"10th_percentile":1843.87,"90th_percentile":2262.51,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":7.98,"10th_percentile":7.98,"90th_percentile":7.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":55.49,"10th_percentile":29.0,"90th_percentile":267.85,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8429.63,"10th_percentile":8429.63,"90th_percentile":8429.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":19.51,"10th_percentile":10.35,"90th_percentile":373.08},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"67","median_amount":172.04,"10th_percentile":31.51,"90th_percentile":458.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":281.7,"10th_percentile":281.7,"90th_percentile":281.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":43.64,"10th_percentile":21.08,"90th_percentile":195.4,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":114.2,"10th_percentile":21.81,"90th_percentile":450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":133.1,"10th_percentile":133.1,"90th_percentile":133.1,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"12","median_amount":147.76,"10th_percentile":17.7,"90th_percentile":477.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"256","median_amount":1200.0,"10th_percentile":20.35,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"13","median_amount":95.69,"10th_percentile":67.85,"90th_percentile":191.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"1 through 10","median_amount":95.58,"10th_percentile":95.58,"90th_percentile":95.58},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"535","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35.04,"10th_percentile":26.1,"90th_percentile":110.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"12","median_amount":65.69,"10th_percentile":17.31,"90th_percentile":178.54,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"1 through 10","median_amount":2499.05,"10th_percentile":2499.05,"90th_percentile":2499.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":224.0,"10th_percentile":161.5,"90th_percentile":282.0},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":84.59,"10th_percentile":84.59,"90th_percentile":84.59,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7.01,"10th_percentile":7.01,"90th_percentile":7.01,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":27.36,"10th_percentile":23.03,"90th_percentile":76.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"91","median_amount":31.16,"10th_percentile":9.67,"90th_percentile":128.37},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":43.05,"10th_percentile":43.05,"90th_percentile":43.05},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"50","median_amount":36.45,"10th_percentile":4.21,"90th_percentile":123.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"172","median_amount":19.86,"10th_percentile":3.86,"90th_percentile":103.65,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"11","median_amount":91.65,"10th_percentile":22.18,"90th_percentile":173.05,"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."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":593.28,"10th_percentile":593.28,"90th_percentile":913.91,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":213.88,"10th_percentile":213.88,"90th_percentile":325.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":207.0,"10th_percentile":196.0,"90th_percentile":1176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"1 through 10","median_amount":1198.74,"10th_percentile":1198.74,"90th_percentile":1198.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":435.0,"10th_percentile":435.0,"90th_percentile":435.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"1 through 10","median_amount":1590.88,"10th_percentile":1590.88,"90th_percentile":1590.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":344.06,"10th_percentile":344.06,"90th_percentile":344.06,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.9,"10th_percentile":110.9,"90th_percentile":363.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"1 through 10","median_amount":422.79,"10th_percentile":422.79,"90th_percentile":422.79,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"13","median_amount":187.41,"10th_percentile":125.57,"90th_percentile":319.41},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":249.66,"10th_percentile":249.66,"90th_percentile":249.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":1576.37,"10th_percentile":1576.37,"90th_percentile":1576.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"63","median_amount":208.03,"10th_percentile":125.03,"90th_percentile":480.81,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"1 through 10","median_amount":956.22,"10th_percentile":956.22,"90th_percentile":1228.91,"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."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"78","median_amount":684.89,"10th_percentile":120.83,"90th_percentile":684.98,"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":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":131.57,"10th_percentile":107.42,"90th_percentile":131.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"1 through 10","median_amount":684.98,"10th_percentile":684.98,"90th_percentile":684.98},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"223","median_amount":825.0,"10th_percentile":825.0,"90th_percentile":876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.57,"10th_percentile":131.57,"90th_percentile":135.39,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"1 through 10","median_amount":876.0,"10th_percentile":876.0,"90th_percentile":876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"1 through 10","median_amount":985.56,"10th_percentile":124.34,"90th_percentile":1821.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.57,"10th_percentile":131.57,"90th_percentile":135.39,"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":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"78","median_amount":1058.43,"10th_percentile":131.57,"90th_percentile":1114.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":83.46,"10th_percentile":83.46,"90th_percentile":83.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"22","median_amount":1079.31,"10th_percentile":1074.83,"90th_percentile":1079.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"262","median_amount":221.44,"10th_percentile":221.44,"90th_percentile":221.44,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":198.59,"10th_percentile":196.83,"90th_percentile":201.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"38","median_amount":95.86,"10th_percentile":95.86,"90th_percentile":1005.73,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"1 through 10","median_amount":256.71,"10th_percentile":256.71,"90th_percentile":256.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104.38,"10th_percentile":104.38,"90th_percentile":104.38,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"331","median_amount":95.86,"10th_percentile":95.86,"90th_percentile":120.83},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"47","median_amount":670.58,"10th_percentile":635.61,"90th_percentile":670.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"680","median_amount":120.83,"10th_percentile":120.83,"90th_percentile":131.57,"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":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","count":"13","median_amount":657.83,"10th_percentile":623.59,"90th_percentile":670.58,"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."}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"1 through 10","median_amount":176.72,"10th_percentile":160.92,"90th_percentile":819.57,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"1 through 10","median_amount":1009.8,"10th_percentile":1009.8,"90th_percentile":1009.8,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"1 through 10","median_amount":784.0,"10th_percentile":784.0,"90th_percentile":784.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"1 through 10","median_amount":145.0,"10th_percentile":145.0,"90th_percentile":444.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":338.03,"10th_percentile":338.03,"90th_percentile":365.68},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"1 through 10","median_amount":1804.98,"10th_percentile":1804.98,"90th_percentile":1804.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.25] [Cardiac Cath (%BC): 38.25] [Lap Banding ($): 27459] [Emergency Department ($): 3212] [CT Scan OP ($): 2200] [MRI OP ($): 2499.12] [Trauma (%BC): 52.60] [All Other OP (%BC): 41.75]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 38.65] [Cardiac Cath (%BC): 38.65] [Lap Banding ($): 25218] [Emergency Department ($): 2878] [CT Scan OP ($): 2318.76] [MRI OP ($): 2035.80] [Trauma (%BC): 53] [All Other OP (%BC): 42.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 699] [OP Surgery Group ($): 13707] [Cardiac Cath ($): 19108] [Emergency Department ($): 5043] [Urgent Care ($): 5043] [Radiation Therapy ($): 4164] [Radiology ($): 876] [Laboratory ($): 876] [Occupational Therapy ($): 207] [Physical Therapy ($): 207] [Resp. Services/Therapy ($): 207] [Speech Therapy ($): 207] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 2018] [IV Therapy ($): 379]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: All Other OP ($): 492] [OP Surgery Group ($): 9670] [Cardiac Cath ($): 13480] [Emergency Department ($): 3557] [Urgent Care ($): 3557] [Radiation Therapy ($): 2937] [Radiology ($): 619] [Laboratory ($): 619] [Occupational Therapy ($): 146] [Physical Therapy ($): 146] [Resp. Services/Therapy ($): 146] [Speech Therapy ($): 146] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1413] [IV Therapy ($): 267]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.50] [Lap Banding ($): 17012] [Emergency Department (%BC): 54.20 Maximum Reimbursement 10243] [Radiology (%BC): 55.30] [Pathology (%BC): 55.30] [OP High Cost Drugs (%BC): 55.30] [IV Therapy (%BC): 55.30] [Trauma (%BC): 60.30] [All Other OP (%BC): 55.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 34.70] [Lap Banding ($): 17012] [Emergency Department (%BC): 59.40 Maximum Reimbursement 11356] [Radiology (%BC): 59.40] [Pathology (%BC): 59.40] [OP High Cost Drugs (%BC): 59.40] [IV Therapy (%BC): 59.40] [Trauma (%BC): 60.30] [All Other OP (%BC): 59.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37 Maximum Reimbursement 2800] [Emergency Department (%BC): 37 Maximum Reimbursement 1200] [All Other OP (%BC): 37 Maximum Reimbursement 2800]","count":"12","median_amount":1103.35,"10th_percentile":753.55,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.52] [Cardiac Cath (%BC): 57.52] [Observation (%BC): 57.52] [Emergency Department ($): 6020] [Chemotherapy (%BC): 57.52] [Radiation Therapy  (%BC): 57.52] [CT Scan OP ($): 4558] [MRI OP ($): 2915] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Trauma (%BC): 73.39] [All Other OP (%BC): 57.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department ($): 1000]","count":"53","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.10] [Cardiac Cath (%BC): 64.40] [Observation ($): 4716] [Emergency Department (%BC): 64.40 Maximum Reimbursement 8091] [Trauma (%BC): 69.50] [All Other OP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Emergency Department (%BC): 11.50 Maximum Reimbursement 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Observation ($): 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.72] [Observation (%BC): 35.72] [Emergency Department (%BC): 35.72] [CT Scan OP ($): 2539] [MRI OP ($): 2899] [Occupational Therapy (%BC): 35.72] [Physical Therapy (%BC): 35.72] [Respiratory Services/Therapy  (%BC): 35.72] [Speech Therapy (%BC): 35.72] [All Other OP (%BC): 35.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 35.05] [Observation (%BC): 35.05] [Emergency Department (%BC): 35.05] [CT Scan OP ($): 2491] [MRI OP ($): 2844] [Occupational Therapy (%BC): 35.05] [Physical Therapy (%BC): 35.05] [Respiratory Services/Therapy  (%BC): 35.05] [Speech Therapy (%BC): 35.05] [All Other OP (%BC): 35.05]","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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":277081.96,"maximum":533936.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":533936.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":429477.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":374060.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277081.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":112395.57,"maximum":216586.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":216586.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174213.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151734.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112395.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":210005.12,"maximum":404679.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":404679.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325507.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":283506.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210005.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":123252.87,"10th_percentile":123252.87,"90th_percentile":123252.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":92671.34,"10th_percentile":92671.34,"90th_percentile":92671.34,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":137254.26,"maximum":264488.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":264488.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":212744.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185293.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137254.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":102319.29,"maximum":197169.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":197169.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158594.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138131.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102319.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46343.82,"maximum":89304.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89304.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71832.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62564.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46343.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":128362.91,"maximum":247355.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":247355.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198962.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173289.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128362.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":55890.28,"maximum":107700.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107700.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86629.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75451.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55890.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pancreas Or Islet Cell Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":71390.95,"maximum":137570.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":137570.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110655.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96377.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71390.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":54405.43,"maximum":104839.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84328.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73447.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54405.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42190.18,"maximum":81300.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81300.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65394.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56956.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42190.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29026.79,"maximum":55934.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44991.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39186.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29026.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":119164.72,"maximum":229630.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":229630.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184705.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160872.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119164.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":59097.76,"maximum":113881.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113881.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91601.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59097.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":54190.35,"maximum":104424.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104424.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83995.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54190.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":426641.61,"maximum":822138.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":822138.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":661294.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":575966.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426641.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":70985.46,"maximum":136788.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136788.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110027.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95830.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70985.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":78229.17,"maximum":150747.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":150747.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105609.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78229.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":52823.89,"maximum":101791.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101791.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81877.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71312.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52823.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31943.21,"maximum":61554.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61554.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49511.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43123.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":57130.45,"maximum":110090.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110090.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88552.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77126.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57130.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":39189.89,"maximum":75518.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75518.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60744.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52906.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39189.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45452.9,"maximum":87587.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87587.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70452.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61361.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45452.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31270.34,"maximum":60257.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60257.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48469.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42214.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31270.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25485.83,"maximum":49111.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49111.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39503.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34405.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25485.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":59873.24,"maximum":115375.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92803.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80828.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59873.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34253.86,"maximum":66007.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66007.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46242.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34253.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22252.7,"maximum":42880.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42880.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34491.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30041.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22252.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":44799.77,"maximum":86329.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86329.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69439.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60479.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44799.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21619.3,"maximum":41660.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41660.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29186.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21619.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17000.96,"maximum":32760.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32760.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26351.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22951.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":38783.4,"maximum":74735.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74735.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60114.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52357.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38783.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24179.56,"maximum":46594.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46594.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37478.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32642.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24179.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19762.49,"maximum":38082.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38082.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26679.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19762.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":33074.86,"maximum":63735.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63735.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51266.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44651.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33074.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16603.36,"maximum":31994.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31994.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25735.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22414.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12192.21,"maximum":23494.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23494.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18897.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16459.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":38689.67,"maximum":74554.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74554.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59968.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52231.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":41442.0,"10th_percentile":41442.0,"90th_percentile":41442.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22287.24,"maximum":42947.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42947.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34545.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30087.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17640.29,"maximum":33992.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33992.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27342.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23814.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17640.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18465.1,"maximum":35582.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35582.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28620.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24927.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10255.49,"maximum":19762.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19762.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15896.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13844.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15659.17,"maximum":30175.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30175.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24271.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21139.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15659.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10751.51,"10th_percentile":10751.51,"90th_percentile":10751.51,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10654.08,"maximum":20530.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20530.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16513.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14383.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24610.51,"10th_percentile":24610.51,"90th_percentile":24610.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12077.73,"10th_percentile":12077.73,"90th_percentile":12077.73,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":347.49,"10th_percentile":347.49,"90th_percentile":347.49,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23514.58,"maximum":45312.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45312.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36447.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31744.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23514.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13377.14,"maximum":25777.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25777.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20734.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17460.73,"maximum":33646.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33646.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27064.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23571.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17460.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10936.0,"10th_percentile":10936.0,"90th_percentile":10936.0,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12837.46,"maximum":24737.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24737.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17330.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9669.44,"maximum":18633.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18633.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14987.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13053.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27796.48,"maximum":53563.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53563.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43084.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27796.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17931.34,"maximum":34553.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27793.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24207.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17931.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14444.65,"maximum":27834.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27834.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22389.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19500.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22430.58,"10th_percentile":22430.58,"90th_percentile":22430.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":35338.71,"10th_percentile":35338.71,"90th_percentile":35338.71,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11150.11,"10th_percentile":11150.11,"90th_percentile":11150.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":16939.35,"10th_percentile":16939.35,"90th_percentile":16939.35,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17394.88,"10th_percentile":17394.88,"90th_percentile":17394.88,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20435.36,"maximum":39378.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39378.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27587.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10059.54,"10th_percentile":10059.54,"90th_percentile":10268.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":23126.58,"10th_percentile":23126.58,"90th_percentile":23126.58,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10736.64,"10th_percentile":10736.64,"90th_percentile":10736.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8519.0,"10th_percentile":8519.0,"90th_percentile":8519.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11150.11,"10th_percentile":11150.11,"90th_percentile":11150.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8383.55,"10th_percentile":8383.55,"90th_percentile":8383.55,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10050.98,"10th_percentile":10050.98,"90th_percentile":10050.98,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":21821.76,"10th_percentile":21821.76,"90th_percentile":21821.76},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7448.21,"10th_percentile":7448.21,"90th_percentile":7448.21,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":9221.89,"10th_percentile":9221.89,"90th_percentile":9221.89,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":21246.94,"10th_percentile":21246.94,"90th_percentile":21246.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10049.55,"10th_percentile":10017.55,"90th_percentile":10293.44,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10562.33,"maximum":20353.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20353.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14259.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8200.87,"10th_percentile":8200.87,"90th_percentile":8200.87,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":14716.72,"10th_percentile":14716.72,"90th_percentile":14716.72,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7155.72,"10th_percentile":7155.72,"90th_percentile":7155.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":6859.73,"10th_percentile":6859.73,"90th_percentile":6859.73},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":346.79,"10th_percentile":346.79,"90th_percentile":346.79,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7346.96,"maximum":14157.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14157.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11387.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9918.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15084.96,"maximum":29068.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29068.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23381.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20364.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9122.86,"maximum":17579.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17579.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14140.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12315.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8212.44,"10th_percentile":8212.44,"90th_percentile":8212.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10735.23,"10th_percentile":10735.23,"90th_percentile":10735.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5542.21,"10th_percentile":5542.21,"90th_percentile":5542.21,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":8229.0,"10th_percentile":8229.0,"90th_percentile":8229.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8246.39,"10th_percentile":8246.39,"90th_percentile":8246.39,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8475.64,"maximum":16332.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16332.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11442.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17019.71,"maximum":32796.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32796.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26380.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22976.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7843.07,"10th_percentile":7843.07,"90th_percentile":7843.07,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10717.23,"maximum":20652.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20652.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16611.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8055.35,"maximum":15522.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12485.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10874.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16286.03,"10th_percentile":16286.03,"90th_percentile":16286.03,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16422.81,"maximum":31646.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31646.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22170.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16422.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":7810.0,"10th_percentile":7810.0,"90th_percentile":7810.0,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9930.94,"10th_percentile":9930.94,"90th_percentile":9930.94,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10753.5,"10th_percentile":10753.5,"90th_percentile":10753.5,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10764.58,"maximum":20743.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20743.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16685.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14532.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19512.88,"maximum":37601.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37601.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30244.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8736.11,"maximum":16834.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16834.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13540.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11793.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18452.27,"maximum":35557.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35557.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28601.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24910.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9430.68,"maximum":18172.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18172.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14617.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12731.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.68,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23144.6,"maximum":44599.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44599.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35874.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31245.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23144.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14365.72,"maximum":27682.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19393.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10024.63,"maximum":19317.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19317.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15538.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13533.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23009.44,"maximum":44339.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44339.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31062.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23009.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":17506.0,"10th_percentile":17506.0,"90th_percentile":17506.0,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13398.04,"10th_percentile":13398.04,"90th_percentile":13398.04,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13447.18,"maximum":25912.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25912.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20843.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18153.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9619.13,"maximum":18536.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18536.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14909.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12985.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13931.61,"maximum":26846.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26846.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21594.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18807.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11433.51,"maximum":22032.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22032.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17721.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15435.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8716.38,"maximum":16796.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16796.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13510.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11767.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9803.83,"10th_percentile":9803.83,"90th_percentile":9803.83,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8401.59,"10th_percentile":8401.59,"90th_percentile":8401.59,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17921.47,"maximum":34534.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34534.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27778.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24193.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7790.17,"10th_percentile":7790.17,"90th_percentile":7790.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12077.72,"10th_percentile":12077.72,"90th_percentile":12077.72,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10695.35,"10th_percentile":10695.35,"90th_percentile":10695.35,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10600.41,"10th_percentile":10600.41,"90th_percentile":10600.41,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":159967.22,"10th_percentile":159967.22,"90th_percentile":159967.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10687.63,"maximum":20595.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20595.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14428.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":4927.76,"10th_percentile":4927.76,"90th_percentile":4927.76,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5743.63,"10th_percentile":5743.63,"90th_percentile":5743.63,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8383.08,"10th_percentile":8383.08,"90th_percentile":8383.08,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":149721.18,"10th_percentile":149721.18,"90th_percentile":149721.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8450.98,"maximum":16285.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16285.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13099.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11408.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35317.43,"maximum":68056.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68056.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54742.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35317.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26041.3,"maximum":50181.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50181.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40364.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35155.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26041.3,"maximum":50181.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50181.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40364.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35155.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26041.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36229.06,"maximum":69813.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56155.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36229.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13208.14,"10th_percentile":13208.14,"90th_percentile":13208.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23236.36,"maximum":44776.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44776.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36016.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31369.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14036.19,"maximum":27047.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27047.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18948.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14036.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":16542.89,"10th_percentile":16542.89,"90th_percentile":16542.89,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":16481.37,"10th_percentile":16481.37,"90th_percentile":16481.37,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13811.52,"10th_percentile":13811.52,"90th_percentile":13811.52,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19620.93,"10th_percentile":19620.93,"90th_percentile":19620.93,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19703.3,"maximum":37968.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37968.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30540.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26599.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7303.46,"10th_percentile":7303.46,"90th_percentile":7303.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5379.85,"10th_percentile":5379.85,"90th_percentile":5379.85,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3911.77,"10th_percentile":3911.77,"90th_percentile":3911.77,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":11290.46,"10th_percentile":11290.46,"90th_percentile":24073.43},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9128.81,"10th_percentile":9128.81,"90th_percentile":9128.81,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9499.75,"maximum":18306.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18306.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12824.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11653.52,"maximum":22456.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22456.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18062.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15732.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7458.0,"10th_percentile":7458.0,"90th_percentile":7458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6560.42,"10th_percentile":6560.42,"90th_percentile":6560.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7354.63,"10th_percentile":7354.63,"90th_percentile":7354.63,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8774.32,"10th_percentile":8774.32,"90th_percentile":8774.32,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8845.62,"maximum":17045.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17045.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13710.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11941.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23790.83,"maximum":45844.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45844.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36875.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23790.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13943.45,"maximum":26869.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26869.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21612.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18823.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15738.1,"maximum":30327.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30327.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24394.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18433.53,"maximum":35521.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35521.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28571.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11298.34,"maximum":21771.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21771.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17512.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15252.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12071.85,"maximum":23262.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23262.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18711.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16297.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8347.38,"maximum":16085.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16085.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12938.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11268.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8347.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":17067.0,"10th_percentile":17067.0,"90th_percentile":17067.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4739.28,"10th_percentile":4739.28,"90th_percentile":4739.28,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8473.67,"maximum":16328.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16328.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13134.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11439.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13648.45,"maximum":26300.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26300.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21155.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18425.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8228.6,"10th_percentile":8228.6,"90th_percentile":8228.6,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8169.79,"maximum":15743.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15743.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12663.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11029.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22004.08,"maximum":42401.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42401.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34106.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29705.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10611.66,"maximum":20448.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20448.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14325.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15326.68,"maximum":29534.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29534.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23756.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20691.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.68,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9337.94,"maximum":17994.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17994.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14473.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12606.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12786.15,"maximum":24638.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24638.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19818.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17261.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42676.58,"maximum":82237.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82237.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66148.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57613.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22113.59,"maximum":42612.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42612.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29853.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16344.87,"maximum":31496.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31496.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25334.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22065.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16344.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37559.01,"maximum":72376.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72376.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58216.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50704.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37559.01,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17691.59,"maximum":34091.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27421.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12456.63,"maximum":24003.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19307.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16816.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12456.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13724.64,"10th_percentile":13724.64,"90th_percentile":13724.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21485.12,"maximum":41401.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41401.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29004.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21485.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13139.36,"maximum":25319.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25319.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20366.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17738.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9424.87,"10th_percentile":9424.87,"90th_percentile":9424.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8458.87,"maximum":16300.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16300.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13111.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11419.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7300.93,"10th_percentile":7300.93,"90th_percentile":7300.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4809.34,"10th_percentile":4809.34,"90th_percentile":6887.48,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7732.89,"10th_percentile":7732.89,"90th_percentile":7732.89,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":5501.84,"10th_percentile":5501.84,"90th_percentile":16510.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7502.84,"10th_percentile":7502.84,"90th_percentile":7502.84,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8009.96,"maximum":15435.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15435.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12415.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10813.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13731.33,"maximum":26460.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26460.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21283.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18537.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7836.32,"maximum":15100.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15100.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12146.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10579.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12258.32,"maximum":23621.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23621.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19000.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":15303.29,"10th_percentile":15303.29,"90th_percentile":15303.29},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7009.94,"10th_percentile":7009.94,"90th_percentile":7009.94,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7877.76,"maximum":15180.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15180.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10634.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16020.27,"maximum":30871.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30871.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24831.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21627.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16020.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":7870.0,"10th_percentile":7870.0,"90th_percentile":7870.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9636.89,"maximum":18570.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18570.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14937.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13009.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":13978.2,"10th_percentile":13978.2,"90th_percentile":13978.2},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7413.06,"maximum":14284.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14284.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11490.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10007.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17532.75,"maximum":33785.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33785.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23669.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4606.14,"10th_percentile":3977.59,"90th_percentile":5502.96,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9570.78,"maximum":18442.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18442.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12920.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5502.96,"10th_percentile":5502.96,"90th_percentile":5502.96,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7584.73,"maximum":14615.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14615.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11756.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10239.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":10395.87,"10th_percentile":10395.87,"90th_percentile":10395.87,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":62667.48,"10th_percentile":62667.48,"90th_percentile":62667.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":44812.59,"maximum":86353.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86353.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69459.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60497.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44812.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25496.69,"maximum":49132.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49132.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39519.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34420.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25496.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19480.32,"maximum":37538.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37538.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30194.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26298.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19480.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":50592.63,"10th_percentile":50592.63,"90th_percentile":50592.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37471.21,"maximum":72207.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37471.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18387.16,"maximum":35432.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35432.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28500.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24822.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14075.66,"maximum":27123.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27123.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21817.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19002.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14075.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29960.12,"maximum":57733.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57733.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46438.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40446.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29960.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15182.0,"10th_percentile":15182.0,"90th_percentile":15182.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14078.72,"10th_percentile":14078.72,"90th_percentile":14078.72,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12505.26,"10th_percentile":12505.26,"90th_percentile":12505.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11134.56,"10th_percentile":11134.56,"90th_percentile":11134.56,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14146.69,"maximum":27260.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27260.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21927.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19098.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":3179.0,"10th_percentile":3179.0,"90th_percentile":3179.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6326.37,"10th_percentile":6326.37,"90th_percentile":6326.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":337.0,"10th_percentile":337.0,"90th_percentile":337.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":7299.83,"10th_percentile":7299.83,"90th_percentile":7299.83,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6351.73,"10th_percentile":6351.73,"90th_percentile":6351.73,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8157.25,"10th_percentile":8157.25,"90th_percentile":8157.25,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":29956.02,"10th_percentile":29956.02,"90th_percentile":29956.02},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8360.4,"10th_percentile":8360.4,"90th_percentile":8360.4,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8536.81,"maximum":16450.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16450.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13232.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10043.75,"10th_percentile":10043.75,"90th_percentile":15627.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":20015.87,"10th_percentile":20015.87,"90th_percentile":20015.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8076.28,"10th_percentile":8076.28,"90th_percentile":8076.28,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14036.08,"10th_percentile":14036.08,"90th_percentile":14036.08,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10870.23,"10th_percentile":10870.23,"90th_percentile":10870.23,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":2986.18,"10th_percentile":2986.18,"90th_percentile":2986.18,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":20584.18,"10th_percentile":20584.18,"90th_percentile":20584.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15634.63,"10th_percentile":13374.58,"90th_percentile":21463.4,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16012.38,"maximum":30855.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30855.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21616.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6727.06,"10th_percentile":6727.06,"90th_percentile":6727.06,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10054.19,"10th_percentile":10054.19,"90th_percentile":10054.19,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9210.35,"10th_percentile":9210.35,"90th_percentile":9210.35,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10223.92,"maximum":19701.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19701.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15847.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13802.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.92,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6270.22,"10th_percentile":6270.22,"90th_percentile":6270.22,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8043.51,"maximum":15499.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15499.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12467.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10858.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16856.13,"10th_percentile":16856.13,"90th_percentile":16856.13,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18018.16,"maximum":34720.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34720.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27928.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24324.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18018.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11161.2,"maximum":21507.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21507.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17299.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15067.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8372.53,"10th_percentile":8372.53,"90th_percentile":8372.53,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8031.67,"maximum":15477.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15477.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12449.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10842.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":28198.64,"10th_percentile":28198.64,"90th_percentile":28198.64},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15688.77,"maximum":30232.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30232.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24317.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":1966.0,"10th_percentile":1966.0,"90th_percentile":1966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5145.73,"10th_percentile":5145.73,"90th_percentile":5145.73,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10496.6,"10th_percentile":10496.6,"90th_percentile":10496.6,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11093.13,"maximum":21376.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21376.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14975.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":22374.0,"10th_percentile":22374.0,"90th_percentile":22374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8354.29,"maximum":16098.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16098.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12949.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11278.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15970.94,"maximum":30776.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30776.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24754.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21560.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10353.17,"maximum":19950.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19950.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16047.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13976.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7670.57,"maximum":14781.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14781.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11889.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10355.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12096.32,"10th_percentile":12096.32,"90th_percentile":12096.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12047.13,"10th_percentile":12047.13,"90th_percentile":12047.13,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11435.75,"10th_percentile":11435.75,"90th_percentile":12415.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8245.43,"10th_percentile":8245.43,"90th_percentile":8245.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6199.59,"10th_percentile":6199.59,"90th_percentile":6199.59,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6199.59,"10th_percentile":6199.59,"90th_percentile":6199.59,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":18885.72,"10th_percentile":18885.72,"90th_percentile":18885.72},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12669.13,"10th_percentile":7263.74,"90th_percentile":12677.86,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":764.87,"10th_percentile":764.87,"90th_percentile":764.87,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12402.73,"10th_percentile":12402.73,"90th_percentile":12402.73,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12457.75,"10th_percentile":12457.75,"90th_percentile":29522.22,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12783.19,"maximum":24633.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24633.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17257.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11010.26,"10th_percentile":11010.26,"90th_percentile":11010.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11020.26,"10th_percentile":11020.26,"90th_percentile":11545.29,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":55785.13,"10th_percentile":55785.13,"90th_percentile":55785.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8175.27,"10th_percentile":8175.27,"90th_percentile":8175.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7406.93,"10th_percentile":7058.36,"90th_percentile":12433.92,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11314.38,"10th_percentile":11314.38,"90th_percentile":11314.38,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10973.87,"10th_percentile":10973.87,"90th_percentile":10973.87,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":10559.96,"10th_percentile":10559.96,"90th_percentile":10559.96},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25.0,"10th_percentile":25.0,"90th_percentile":10755.46,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11523.29,"maximum":22205.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22205.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17861.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15556.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7566.53,"10th_percentile":7566.53,"90th_percentile":7566.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7058.36,"10th_percentile":7058.36,"90th_percentile":12433.92,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8807.28,"10th_percentile":8807.28,"90th_percentile":8807.28,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8911.73,"maximum":17172.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13813.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12030.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6591.92,"10th_percentile":6591.92,"90th_percentile":6591.92,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6928.63,"maximum":13351.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13351.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10739.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9353.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6343.26,"10th_percentile":6343.26,"90th_percentile":6343.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13188.8,"10th_percentile":12865.46,"90th_percentile":13457.96,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10274.18,"10th_percentile":7416.25,"90th_percentile":10274.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7724.96,"10th_percentile":6224.61,"90th_percentile":9656.2,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12864.51,"10th_percentile":12784.07,"90th_percentile":13222.32,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5576.13,"10th_percentile":5576.13,"90th_percentile":5576.13,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3000.0,"10th_percentile":3000.0,"90th_percentile":3000.0,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":12867.96,"10th_percentile":12867.96,"90th_percentile":12867.96},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12067.54,"10th_percentile":12.04,"90th_percentile":13230.81,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13562.62,"maximum":26135.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21022.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18309.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8413.35,"10th_percentile":8413.35,"90th_percentile":8413.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":14916.0,"10th_percentile":14916.0,"90th_percentile":14916.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7203.11,"10th_percentile":7203.11,"90th_percentile":7203.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":6381.49,"10th_percentile":6381.49,"90th_percentile":6381.49,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5415.88,"10th_percentile":5415.88,"90th_percentile":5415.88,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8397.35,"10th_percentile":8207.83,"90th_percentile":8430.87,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":6133.74,"10th_percentile":6133.74,"90th_percentile":6133.74,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":7683.72,"10th_percentile":7683.72,"90th_percentile":7683.72},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":15567.6,"10th_percentile":15567.6,"90th_percentile":15567.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8200.27,"10th_percentile":8177.27,"90th_percentile":8203.27,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8545.69,"maximum":16467.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16467.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11536.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8545.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15682.0,"10th_percentile":15682.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5279.53,"10th_percentile":5279.53,"90th_percentile":5279.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":2846.57,"10th_percentile":2846.57,"90th_percentile":2846.57,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6795.44,"maximum":13094.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13094.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10532.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9173.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9114.21,"10th_percentile":9114.21,"90th_percentile":9114.21,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18675.19,"10th_percentile":18675.19,"90th_percentile":18675.19,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18641.67,"10th_percentile":18641.67,"90th_percentile":18641.67,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19213.94,"maximum":37025.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37025.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29781.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25938.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9958.52,"maximum":19190.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19190.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15435.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13444.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7660.7,"maximum":14762.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14762.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11874.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10341.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17849.02,"10th_percentile":17849.02,"90th_percentile":17849.02,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17999.42,"maximum":34684.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27899.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24299.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17999.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11440.41,"maximum":22045.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22045.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17732.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15444.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.41,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4382.46,"10th_percentile":4382.46,"90th_percentile":4382.46,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7649.85,"maximum":14741.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14741.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11857.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":25170.0,"10th_percentile":25170.0,"90th_percentile":25170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8874.12,"10th_percentile":8874.12,"90th_percentile":8874.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5869.29,"10th_percentile":5869.29,"90th_percentile":6796.13,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":23259.65,"10th_percentile":23259.65,"90th_percentile":23259.65},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6878.82,"10th_percentile":6878.82,"90th_percentile":6878.82,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":9517.61,"10th_percentile":9517.61,"90th_percentile":9517.61},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10176.56,"maximum":19610.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19610.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15773.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13738.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":14916.0,"10th_percentile":14916.0,"90th_percentile":14916.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7204.89,"maximum":13883.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13883.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9726.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8560.49,"maximum":16496.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16496.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13268.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11556.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18659.46,"maximum":35956.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35956.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28922.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4382.46,"10th_percentile":4382.46,"90th_percentile":4382.46,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9256.88,"10th_percentile":9256.88,"90th_percentile":9256.88,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9879.59,"maximum":19037.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19037.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15313.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13337.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":20039.36,"10th_percentile":20039.36,"90th_percentile":20039.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62764.11,"10th_percentile":62764.11,"90th_percentile":62764.11,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":64080.15,"maximum":123482.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123482.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99324.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86508.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64080.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":18891.0,"10th_percentile":18891.0,"90th_percentile":18891.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":19444.39,"10th_percentile":19444.39,"90th_percentile":19444.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26878.09,"10th_percentile":26878.09,"90th_percentile":26878.09,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":16081.82,"10th_percentile":16081.82,"90th_percentile":16081.82,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":25911.42,"10th_percentile":25911.42,"90th_percentile":25911.42},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26340.53,"10th_percentile":26340.53,"90th_percentile":26340.53,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27713.61,"maximum":53404.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53404.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42956.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37413.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27713.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":112267.31,"maximum":216339.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":216339.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174014.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151560.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112267.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":107879.84,"maximum":207884.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":207884.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167213.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107879.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":56899.59,"maximum":109645.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109645.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88194.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76814.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56899.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":98831.62,"maximum":190448.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":190448.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153189.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133422.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98831.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":97112.94,"maximum":187136.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":187136.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150525.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97112.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":65467.33,"maximum":126155.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126155.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101474.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88380.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":65467.33,"maximum":126155.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126155.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101474.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88380.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65467.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":76349.67,"maximum":147125.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147125.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118341.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103072.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76349.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":53208.67,"maximum":102533.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102533.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82473.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71831.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53208.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":50321.84,"maximum":96970.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96970.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77998.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67934.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":49406.26,"maximum":95205.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95205.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76579.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66698.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49406.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31667.95,"maximum":61024.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61024.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42751.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":83765.05,"maximum":161415.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":161415.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129835.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113082.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83765.05,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":60408.97,"maximum":116408.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93633.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81552.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60408.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":76023.1,"maximum":146496.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":146496.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102631.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76023.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":54490.28,"maximum":105002.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105002.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73561.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54490.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":58494.94,"maximum":112719.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112719.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78968.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58494.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41921.82,"maximum":80783.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80783.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56594.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41921.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34834.86,"10th_percentile":34834.86,"90th_percentile":34834.86,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":18113.3,"10th_percentile":18113.3,"90th_percentile":18113.3,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":49152.7,"maximum":94717.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94717.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76186.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66356.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49152.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28717.98,"maximum":55339.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55339.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44512.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38769.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14253.25,"maximum":27466.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27466.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22092.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19241.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14253.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32095.15,"maximum":61847.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49747.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43328.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32095.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21618.31,"maximum":41658.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41658.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33508.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29184.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21618.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17986.11,"10th_percentile":17986.11,"90th_percentile":17986.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17858.27,"10th_percentile":17858.27,"90th_percentile":17858.27,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18427.61,"maximum":35510.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35510.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28562.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24877.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18427.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45607.8,"maximum":87886.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87886.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70692.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45607.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22127.4,"maximum":42639.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42639.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34297.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29871.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22127.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15339.51,"maximum":29559.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29559.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20708.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33528.21,"10th_percentile":33528.21,"90th_percentile":33528.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33324.64,"10th_percentile":33324.64,"90th_percentile":33324.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32632.7,"10th_percentile":32632.7,"90th_percentile":32632.7,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35010.59,"maximum":67465.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67465.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54266.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47264.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35010.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26203.1,"maximum":50493.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50493.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40614.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35374.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26203.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18173.06,"maximum":35019.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35019.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28168.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27207.47,"maximum":52428.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52428.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42171.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36730.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17346.28,"maximum":33426.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33426.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26886.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23417.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11370.36,"maximum":21910.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21910.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15349.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31594.94,"maximum":60883.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48972.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42653.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31594.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20544.88,"maximum":39589.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39589.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31844.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27735.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32687.12,"maximum":62988.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50665.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32687.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19246.49,"maximum":37087.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37087.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29832.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25982.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16675.38,"maximum":32133.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32133.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22511.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16675.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30759.28,"maximum":59273.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59273.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47676.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41525.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30759.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":39391.26,"10th_percentile":39391.26,"90th_percentile":39391.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33204.54,"10th_percentile":33204.54,"90th_percentile":33204.54,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":33553.37,"maximum":64657.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64657.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52007.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45297.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36292.2,"maximum":69935.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69935.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56252.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48994.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36292.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":61058.16,"maximum":117659.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117659.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82428.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61058.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":47565.24,"maximum":91658.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73726.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":68452.82,"maximum":131908.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":131908.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106101.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92411.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68452.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42261.21,"maximum":81437.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81437.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65504.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57052.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58830.96,"10th_percentile":58830.96,"90th_percentile":58830.96,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":52651.23,"maximum":101458.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101458.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81609.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71079.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52651.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":82128.24,"10th_percentile":82128.24,"90th_percentile":82128.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":159108.95,"10th_percentile":159108.95,"90th_percentile":159108.95,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":32718.43,"10th_percentile":32718.43,"90th_percentile":32718.43,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":48664.1,"10th_percentile":48664.1,"90th_percentile":48664.1,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35681.49,"maximum":68758.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68758.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55306.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48170.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35681.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25782.8,"maximum":49683.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49683.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39963.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34806.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25782.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41297.29,"maximum":79579.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79579.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64010.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":33070.91,"maximum":63727.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63727.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51259.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44645.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33070.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":70944.02,"maximum":136709.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109963.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95774.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70944.02,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":59856.46,"maximum":115343.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115343.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92777.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80806.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59856.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46161.29,"maximum":88952.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71550.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62317.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46161.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":55511.42,"maximum":106970.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106970.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86042.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74940.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55511.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36175.78,"maximum":69710.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69710.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56072.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48837.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36175.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17.26,"10th_percentile":17.26,"90th_percentile":17.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10291.49,"10th_percentile":10291.49,"90th_percentile":10291.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5825.25,"10th_percentile":5825.25,"90th_percentile":5825.25,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8370.27,"10th_percentile":8370.27,"90th_percentile":8370.27,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18750.89,"10th_percentile":18750.89,"90th_percentile":18750.89,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":62405.16,"10th_percentile":62405.16,"90th_percentile":62405.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16420.84,"maximum":31642.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31642.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25452.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22168.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7695.0,"10th_percentile":7695.0,"90th_percentile":7695.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":34080.0,"10th_percentile":34080.0,"90th_percentile":34080.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3247.5,"10th_percentile":3247.5,"90th_percentile":3247.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9127.75,"10th_percentile":9127.75,"90th_percentile":9127.75,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9367.7,"10th_percentile":9367.7,"90th_percentile":9367.7,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9662.54,"maximum":18619.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18619.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14976.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13044.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6795.12,"10th_percentile":6795.12,"90th_percentile":6795.12,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7728.78,"maximum":14893.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14893.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11979.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10433.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19722.53,"10th_percentile":19722.53,"90th_percentile":19722.53,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":19722.53,"10th_percentile":19722.53,"90th_percentile":19722.53},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20137.41,"maximum":38804.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38804.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31212.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27185.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.41,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7423.91,"maximum":14305.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11507.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10022.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6503.4,"maximum":12532.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12532.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10080.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8779.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22426.35,"maximum":43215.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43215.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34760.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30275.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11152.32,"maximum":21490.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21490.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15055.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11152.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27294.3,"maximum":52596.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52596.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42306.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36847.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27294.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17435.07,"maximum":33597.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33597.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27024.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23537.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9767.12,"maximum":18821.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18821.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15139.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13185.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":22956.0,"10th_percentile":22956.0,"90th_percentile":22956.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12739.24,"10th_percentile":5636.88,"90th_percentile":13092.61,"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":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":4508.0,"10th_percentile":4508.0,"90th_percentile":4508.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13064.61,"10th_percentile":13064.61,"90th_percentile":13064.61,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":6907.0,"10th_percentile":6907.0,"90th_percentile":6907.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12888.22,"10th_percentile":12888.22,"90th_percentile":13064.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":65010.0,"10th_percentile":65010.0,"90th_percentile":65010.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11019.65,"10th_percentile":7747.57,"90th_percentile":11422.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"14","median_amount":8285.46,"10th_percentile":5825.25,"90th_percentile":9228.18,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":12744.76,"10th_percentile":12743.8,"90th_percentile":13098.13,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":16743.33,"10th_percentile":16743.33,"90th_percentile":16743.33},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4502.96,"10th_percentile":4502.96,"90th_percentile":4502.96,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13151.24,"10th_percentile":13151.24,"90th_percentile":13151.24,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":9114.0,"10th_percentile":9114.0,"90th_percentile":9114.0,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12663.67,"10th_percentile":12663.67,"90th_percentile":12663.67,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":12970.65,"10th_percentile":12970.65,"90th_percentile":63764.33},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":55423.06,"10th_percentile":55423.06,"90th_percentile":55423.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":12711.24,"10th_percentile":11167.74,"90th_percentile":13067.11,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13260.72,"maximum":25553.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25553.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20554.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17901.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8609.19,"10th_percentile":8609.19,"90th_percentile":8609.19,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3478.84,"10th_percentile":3478.84,"90th_percentile":3478.84,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8573.48,"10th_percentile":8573.48,"90th_percentile":8573.48,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8562.76,"10th_percentile":8562.76,"90th_percentile":8562.76,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8970.92,"maximum":17286.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17286.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13904.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12110.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.92,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":14221.45,"10th_percentile":14221.45,"90th_percentile":14221.45},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5392.52,"10th_percentile":5392.52,"90th_percentile":5392.52,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6178.81,"maximum":11906.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11906.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9577.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8341.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15865.97,"10th_percentile":15865.97,"90th_percentile":15865.97,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16004.49,"maximum":30840.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30840.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24806.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21606.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6849.71,"maximum":13199.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13199.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10617.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9247.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5084.65,"maximum":9798.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9798.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7881.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6864.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10291.49,"10th_percentile":10291.49,"90th_percentile":10291.49,"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":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15747.92,"10th_percentile":15747.92,"90th_percentile":15747.92,"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":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13611.25,"10th_percentile":13611.25,"90th_percentile":13611.25,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16703.01,"maximum":32186.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32186.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25889.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22549.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.01,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4138.64,"10th_percentile":4138.64,"90th_percentile":8629.77,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10348.49,"10th_percentile":10348.49,"90th_percentile":10348.49,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11126.67,"maximum":21441.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21441.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15021.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11126.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7286.98,"10th_percentile":7286.98,"90th_percentile":7286.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7296.51,"10th_percentile":7296.51,"90th_percentile":7296.51,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7695.23,"maximum":14828.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14828.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11927.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10388.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12400.39,"maximum":23895.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23895.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19220.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16740.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7236.46,"maximum":13944.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13944.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11216.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9769.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12022.64,"10th_percentile":12022.64,"90th_percentile":12022.64,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7119.24,"10th_percentile":7119.24,"90th_percentile":7119.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11367.22,"10th_percentile":11367.22,"90th_percentile":11367.22,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12335.27,"maximum":23770.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23770.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19119.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16652.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7591.0,"10th_percentile":7591.0,"90th_percentile":7591.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7748.19,"10th_percentile":7748.19,"90th_percentile":7748.19,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7436.19,"10th_percentile":7436.19,"90th_percentile":7436.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5352.83,"10th_percentile":5352.83,"90th_percentile":5352.83,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7887.95,"10th_percentile":7887.95,"90th_percentile":7887.95,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":12247.31,"10th_percentile":12247.31,"90th_percentile":12247.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":346.09,"10th_percentile":346.09,"90th_percentile":346.09,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8044.49,"maximum":15501.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15501.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12468.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16141.62,"maximum":31104.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31104.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25019.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21791.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9604.33,"maximum":18507.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18507.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14886.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12965.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13937.35,"10th_percentile":13937.35,"90th_percentile":13937.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":39205.0,"10th_percentile":39205.0,"90th_percentile":39205.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7593.84,"10th_percentile":7593.84,"90th_percentile":7593.84,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":24687.0,"10th_percentile":24687.0,"90th_percentile":24687.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":44450.72,"10th_percentile":44450.72,"90th_percentile":44450.72},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12026.42,"10th_percentile":12026.42,"90th_percentile":12026.42,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":11909.67,"10th_percentile":11909.67,"90th_percentile":11909.67},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11857.68,"10th_percentile":11857.68,"90th_percentile":11857.68,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12473.4,"maximum":24036.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24036.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19333.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":25188.0,"10th_percentile":25188.0,"90th_percentile":25188.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":9199.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5048.97,"10th_percentile":5048.97,"90th_percentile":5048.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6634.69,"10th_percentile":6634.69,"90th_percentile":6634.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7653.95,"10th_percentile":7653.95,"90th_percentile":7653.95,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":7571.65,"10th_percentile":7571.65,"90th_percentile":7571.65},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":20875.44,"10th_percentile":20875.44,"90th_percentile":20875.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7604.81,"10th_percentile":7604.81,"90th_percentile":7628.44,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":14440.39,"10th_percentile":14440.39,"90th_percentile":14440.39}]},{"setting":"inpatient","billing_class":"facility","minimum":7853.09,"maximum":15132.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15132.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12172.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10601.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7841.0,"10th_percentile":7841.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3796.23,"10th_percentile":3796.23,"90th_percentile":3796.23,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6009.65,"10th_percentile":6009.65,"90th_percentile":6009.65,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":14050.7,"10th_percentile":14050.7,"90th_percentile":14050.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5737.93,"10th_percentile":5737.93,"90th_percentile":5737.93,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6179.8,"maximum":11908.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11908.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9578.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8342.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8519.0,"10th_percentile":8519.0,"90th_percentile":8519.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5441.93,"10th_percentile":5441.93,"90th_percentile":5441.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7519.62,"maximum":14490.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11655.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10151.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10226.9,"10th_percentile":10226.9,"90th_percentile":10226.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7951.25,"10th_percentile":7951.25,"90th_percentile":7951.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5642.09,"10th_percentile":5642.09,"90th_percentile":5642.09,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8924.74,"10th_percentile":8924.74,"90th_percentile":8924.74,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9193.9,"maximum":17716.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17716.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14250.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12411.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4139.74,"10th_percentile":4091.69,"90th_percentile":4911.43,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7698.19,"maximum":14834.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14834.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11932.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10392.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8884.85,"10th_percentile":8884.85,"90th_percentile":8884.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5758.19,"10th_percentile":5758.19,"90th_percentile":5758.19,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":11085.87,"10th_percentile":11085.87,"90th_percentile":11085.87,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21167.43,"maximum":40789.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40789.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32809.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28576.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7841.0,"10th_percentile":7841.0,"90th_percentile":7841.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10098.62,"maximum":19460.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19460.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15652.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13633.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7324.27,"maximum":14113.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14113.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11352.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9887.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":66564.44,"maximum":128269.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128269.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103174.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89861.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66564.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24492.32,"maximum":47196.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47196.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37963.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33064.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24492.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":44626.12,"maximum":85994.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85994.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69170.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60245.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44626.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24325.58,"maximum":46875.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46875.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37704.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32839.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27438.34,"maximum":52873.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52873.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42529.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37041.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17920.58,"10th_percentile":17920.58,"90th_percentile":17920.58,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17988.56,"maximum":34663.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34663.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27882.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24284.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":43289.26,"maximum":83418.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83418.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67098.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58440.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43289.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31682.75,"maximum":61052.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61052.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49108.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42771.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32268.8,"maximum":62181.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62181.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50016.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43562.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37263.03,"10th_percentile":37263.03,"90th_percentile":37263.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":100430.0,"10th_percentile":100430.0,"90th_percentile":100430.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":19008.27,"10th_percentile":19008.27,"90th_percentile":19008.27,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":49800.91,"maximum":95966.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95966.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77191.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49800.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27462.69,"10th_percentile":27462.69,"90th_percentile":27462.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":47506.41,"10th_percentile":47506.41,"90th_percentile":47506.41,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6833.4,"10th_percentile":6833.4,"90th_percentile":6833.4,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24709.37,"maximum":47614.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47614.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38299.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33357.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24709.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12005.64,"10th_percentile":12005.64,"90th_percentile":12005.64,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16403.08,"maximum":31608.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31608.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25424.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22144.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40791.4,"10th_percentile":40791.4,"90th_percentile":40791.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":31364.0,"10th_percentile":31364.0,"90th_percentile":31364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":187247.14,"10th_percentile":187247.14,"90th_percentile":187247.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":14980.0,"10th_percentile":14980.0,"90th_percentile":14980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39237.9,"10th_percentile":39237.9,"90th_percentile":39237.9,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45944.24,"maximum":88534.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71213.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62024.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45944.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":56673.0,"10th_percentile":56673.0,"90th_percentile":56673.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":74643.0,"10th_percentile":74643.0,"90th_percentile":74643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":21019.36,"10th_percentile":21019.36,"90th_percentile":21019.36,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":17736.95,"10th_percentile":17736.95,"90th_percentile":17736.95,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":47413.71,"10th_percentile":47413.71,"90th_percentile":47413.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18396.8,"10th_percentile":18396.8,"90th_percentile":18396.8,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24245.66,"maximum":46721.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46721.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37580.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32731.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7386.0,"10th_percentile":7386.0,"90th_percentile":7386.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":27628.0,"10th_percentile":27628.0,"90th_percentile":27628.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":16491.09,"10th_percentile":16491.09,"90th_percentile":16491.09,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":37771.81,"10th_percentile":37771.81,"90th_percentile":37771.81},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":38263.75,"10th_percentile":38263.75,"90th_percentile":38263.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17198.29,"maximum":33141.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33141.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26657.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23217.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36316.87,"maximum":69982.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69982.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56291.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49027.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36316.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23703.02,"maximum":45675.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45675.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36739.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31999.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.02,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16754.31,"maximum":32285.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32285.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25969.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22618.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37468.87,"10th_percentile":37468.87,"90th_percentile":37468.87,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53017.86,"10th_percentile":53017.86,"90th_percentile":53017.86,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35825.54,"maximum":69035.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69035.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55529.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10055.06,"10th_percentile":10055.06,"90th_percentile":10055.06,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21399.28,"maximum":41236.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41236.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33168.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28889.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21399.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15682.0,"10th_percentile":15682.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15739.09,"maximum":30329.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30329.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24395.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21247.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26076.82,"maximum":50250.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50250.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40419.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26076.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14835.06,"10th_percentile":14835.06,"90th_percentile":14835.06,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15440.14,"maximum":29753.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29753.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23932.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20844.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15440.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6762.09,"10th_percentile":6762.09,"90th_percentile":6762.09,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":7438.29,"10th_percentile":7438.29,"90th_percentile":7438.29,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12297.78,"maximum":23697.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23697.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19061.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23243.26,"maximum":44789.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44789.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36027.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31378.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23243.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":23523.0,"10th_percentile":23523.0,"90th_percentile":23523.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11340.47,"10th_percentile":11340.47,"90th_percentile":11340.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13507.37,"maximum":26028.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26028.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20936.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18234.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9184.03,"maximum":17697.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17697.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12398.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.03,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25179.98,"maximum":48521.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39028.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33992.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15635.49,"maximum":30129.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30129.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21107.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":17256.0,"10th_percentile":17256.0,"90th_percentile":17256.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9905.92,"10th_percentile":9905.92,"90th_percentile":9905.92,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12116.24,"maximum":23347.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23347.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18780.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16356.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29226.08,"maximum":56318.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56318.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45300.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39455.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17193.35,"maximum":33131.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33131.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26649.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23211.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10313.66,"10th_percentile":10313.66,"90th_percentile":10313.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7883.1,"10th_percentile":7883.1,"90th_percentile":9731.73,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13864.52,"maximum":26716.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26716.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21490.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18717.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13447.11,"10th_percentile":13447.11,"90th_percentile":13447.11,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":43934.51,"maximum":84661.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84661.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68098.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43934.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8101.47,"10th_percentile":8101.47,"90th_percentile":8101.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":8509.36,"10th_percentile":8509.36,"90th_percentile":8509.36,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23538.26,"maximum":45358.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45358.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36484.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31776.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14386.44,"maximum":27722.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27722.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22298.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19421.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34520.25,"maximum":66520.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53506.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46602.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24414.37,"maximum":47046.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47046.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37842.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32959.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16300.47,"maximum":31411.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31411.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25265.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10462.68,"maximum":20161.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20161.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14124.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.68,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7508.76,"maximum":14469.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14469.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11638.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10136.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8887.89,"10th_percentile":8887.89,"90th_percentile":8887.89,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18088.21,"maximum":34855.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28036.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24419.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18088.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":31485.0,"10th_percentile":31485.0,"90th_percentile":31485.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1050.0,"10th_percentile":1050.0,"90th_percentile":1050.0,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6005.41,"10th_percentile":6005.41,"90th_percentile":6005.41,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10445.83,"10th_percentile":10445.83,"90th_percentile":10445.83,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8815.46,"10th_percentile":8815.46,"90th_percentile":8815.46,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10667.9,"maximum":20557.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20557.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16535.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14401.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6123.51,"10th_percentile":6123.51,"90th_percentile":6123.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7322.71,"10th_percentile":7322.71,"90th_percentile":7322.71,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":23989.0,"10th_percentile":23989.0,"90th_percentile":23989.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7771.2,"maximum":14975.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14975.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12045.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10491.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18686.43,"10th_percentile":18686.43,"90th_percentile":18686.43,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21695.27,"maximum":41806.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41806.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33627.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29288.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21695.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9504.61,"10th_percentile":9504.61,"90th_percentile":9504.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8157.58,"10th_percentile":8157.58,"90th_percentile":8157.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9820.84,"10th_percentile":9820.84,"90th_percentile":9820.84,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":10802.91,"10th_percentile":10802.91,"90th_percentile":10802.91,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12528.65,"maximum":24142.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19419.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16913.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9713.84,"maximum":18718.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15056.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13113.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18138.05,"10th_percentile":18138.05,"90th_percentile":18138.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6559.91,"10th_percentile":6559.91,"90th_percentile":6559.91,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":21342.12,"10th_percentile":21342.12,"90th_percentile":21342.12},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16487.6,"10th_percentile":16487.6,"90th_percentile":16487.6,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18629.86,"maximum":35899.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35899.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28876.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25150.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18629.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":11790.98,"10th_percentile":11790.98,"90th_percentile":11790.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11914.22,"10th_percentile":11914.22,"90th_percentile":12819.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5923.34,"10th_percentile":5923.34,"90th_percentile":5923.34,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7185.86,"10th_percentile":7185.86,"90th_percentile":7185.86,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9727.49,"10th_percentile":9727.49,"90th_percentile":9727.49,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10270.29,"maximum":19790.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19790.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15918.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13864.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8515.67,"10th_percentile":8515.67,"90th_percentile":8515.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4963.48,"10th_percentile":4963.48,"90th_percentile":5484.97,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6768.04,"10th_percentile":6768.04,"90th_percentile":6768.04,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6814.19,"maximum":13130.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13130.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10561.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9199.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8924.04,"10th_percentile":8924.04,"90th_percentile":8924.04,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19953.9,"maximum":38451.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38451.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30928.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26937.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19953.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11284.53,"maximum":21745.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21745.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17491.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15234.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8258.74,"10th_percentile":8258.74,"90th_percentile":8258.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8493.4,"maximum":16366.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13164.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11466.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14216.74,"maximum":27395.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27395.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22035.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19192.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":16894.13,"10th_percentile":16894.13,"90th_percentile":16894.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9028.15,"maximum":17397.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17397.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13993.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12188.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15719.28,"10th_percentile":15719.28,"90th_percentile":15719.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16205.75,"maximum":31228.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31228.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25118.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16205.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6788.61,"10th_percentile":6788.61,"90th_percentile":6788.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"1 through 10","median_amount":31364.0,"10th_percentile":31364.0,"90th_percentile":31364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8257.41,"10th_percentile":8257.41,"90th_percentile":8257.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9010.85,"10th_percentile":9010.85,"90th_percentile":9010.85,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10226.88,"maximum":19707.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19707.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15851.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7316.37,"maximum":14098.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14098.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11340.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9877.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7004.76,"10th_percentile":7004.76,"90th_percentile":7004.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8611.76,"10th_percentile":7897.12,"90th_percentile":13627.6,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1632.0,"10th_percentile":1632.0,"90th_percentile":1632.0,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15164.88,"maximum":29222.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23505.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20472.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"1 through 10","median_amount":15682.0,"10th_percentile":15682.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":29960.0,"10th_percentile":29960.0,"90th_percentile":29960.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5449.91,"10th_percentile":5449.91,"90th_percentile":5449.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":6247.99,"10th_percentile":6247.99,"90th_percentile":6247.99,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5164.82,"10th_percentile":5164.82,"90th_percentile":5266.75,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":4507.45,"10th_percentile":4507.45,"90th_percentile":4507.45,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":13606.76,"10th_percentile":13606.76,"90th_percentile":13606.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8005.62,"10th_percentile":8005.62,"90th_percentile":8005.62,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8386.85,"maximum":16161.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16161.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12999.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11322.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7091.0,"10th_percentile":6272.8,"90th_percentile":13764.41,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1344.31,"10th_percentile":1344.31,"90th_percentile":1344.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":22470.0,"10th_percentile":14980.0,"90th_percentile":43882.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6869.2,"10th_percentile":6869.2,"90th_percentile":6869.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4097.7,"10th_percentile":4097.7,"90th_percentile":4097.7,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":4507.45,"10th_percentile":4507.45,"90th_percentile":4507.45,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5810.07,"10th_percentile":5810.07,"90th_percentile":5810.07,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5961.75,"maximum":11488.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11488.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9240.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8048.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":31364.0,"10th_percentile":31364.0,"90th_percentile":31364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":24249.0,"10th_percentile":24249.0,"90th_percentile":24249.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9477.57,"10th_percentile":9477.57,"90th_percentile":9477.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5484.97,"10th_percentile":5484.97,"90th_percentile":6953.27,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14799.56,"10th_percentile":14799.56,"90th_percentile":14799.56,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12442.36,"10th_percentile":12442.36,"90th_percentile":12442.36,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13107.79,"maximum":25258.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25258.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20317.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17695.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":6902.03,"10th_percentile":6902.03,"90th_percentile":18891.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8018.15,"10th_percentile":8018.15,"90th_percentile":8018.15,"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":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8091.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8061.34,"10th_percentile":8061.34,"90th_percentile":8061.34,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":23682.0,"10th_percentile":22470.0,"90th_percentile":24249.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6996.77,"10th_percentile":5452.59,"90th_percentile":7875.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":14368.38,"10th_percentile":14368.38,"90th_percentile":14368.38,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"21","median_amount":4933.72,"10th_percentile":3942.56,"90th_percentile":5921.34,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8048.67,"10th_percentile":8048.67,"90th_percentile":8048.67,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":800.0,"10th_percentile":800.0,"90th_percentile":800.0,"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":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7963.09,"10th_percentile":7963.09,"90th_percentile":7963.09,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":6429.79,"10th_percentile":6429.79,"90th_percentile":6429.79,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9266.64,"10th_percentile":9266.64,"90th_percentile":9266.64,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":2509.37,"10th_percentile":2509.37,"90th_percentile":2509.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7565.94,"10th_percentile":345.79,"90th_percentile":20264.97,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":2509.25,"10th_percentile":2509.25,"90th_percentile":2509.25}]},{"setting":"inpatient","billing_class":"facility","minimum":8286.21,"maximum":15967.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15967.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12843.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11186.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8641.95,"10th_percentile":8641.95,"90th_percentile":14403.59,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16781.32,"10th_percentile":16781.32,"90th_percentile":16781.32,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":347.29,"10th_percentile":347.29,"90th_percentile":347.29,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16373.48,"maximum":31551.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31551.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25378.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22104.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10710.65,"10th_percentile":10710.65,"90th_percentile":10710.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":56220.54,"10th_percentile":56220.54,"90th_percentile":56220.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8652.78,"10th_percentile":8652.78,"90th_percentile":8652.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8569.72,"10th_percentile":8569.72,"90th_percentile":8569.72,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9565.13,"10th_percentile":9565.13,"90th_percentile":9565.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":460.0,"10th_percentile":460.0,"90th_percentile":460.0,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9826.32,"maximum":18935.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18935.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15230.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13265.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":6832.0,"10th_percentile":6832.0,"90th_percentile":6832.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5738.79,"10th_percentile":5738.79,"90th_percentile":5738.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4355.96,"10th_percentile":4355.96,"90th_percentile":6962.48,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":344.79,"10th_percentile":344.79,"90th_percentile":344.79,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6997.7,"maximum":13484.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13484.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10846.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9446.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24222.97,"maximum":46677.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46677.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37545.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32701.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24222.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11595.44,"10th_percentile":11595.44,"90th_percentile":11595.44,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":12368.93,"10th_percentile":12368.93,"90th_percentile":12368.93,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15104.44,"10th_percentile":15104.44,"90th_percentile":15104.44,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":119879.06,"10th_percentile":119879.06,"90th_percentile":119879.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15527.95,"maximum":29922.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29922.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24068.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20962.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":12688.72,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12685.17,"10th_percentile":9688.45,"90th_percentile":14955.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9012.98,"10th_percentile":9012.98,"90th_percentile":9537.72,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":15062.0,"10th_percentile":15062.0,"90th_percentile":15062.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":804.89,"10th_percentile":804.89,"90th_percentile":804.89},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11017.74,"10th_percentile":11017.74,"90th_percentile":11017.74,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":2424.47,"10th_percentile":2424.47,"90th_percentile":2424.47}]},{"setting":"inpatient","billing_class":"facility","minimum":11888.34,"maximum":22908.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22908.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18426.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16049.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":40261.35,"maximum":77583.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77583.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62405.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54352.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40261.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":54567.23,"maximum":105151.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105151.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84579.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73665.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54567.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29208.32,"maximum":56284.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45272.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39431.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29208.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22493.44,"maximum":43344.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43344.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34864.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30366.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22493.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35773.25,"maximum":68935.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68935.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55448.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22076.1,"maximum":42540.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29802.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22076.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16259.03,"maximum":31331.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25201.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21949.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.03,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":33185.36,"maximum":63948.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63948.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51437.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44800.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33185.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21338.11,"maximum":41118.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33074.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28806.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21338.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16977.29,"maximum":32715.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32715.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26314.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22919.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16977.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35743.65,"maximum":68878.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68878.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55402.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48253.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35743.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20984.91,"maximum":40437.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40437.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32526.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28329.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14045.07,"maximum":27064.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27064.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21769.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18960.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":23523.0,"10th_percentile":23523.0,"90th_percentile":23523.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36186.27,"10th_percentile":36186.27,"90th_percentile":36186.27,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22738.48,"10th_percentile":22738.48,"90th_percentile":22738.48,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24139.11,"maximum":46516.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46516.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37415.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32587.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24139.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16480.79,"10th_percentile":16480.79,"90th_percentile":16480.79,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12386.26,"10th_percentile":12386.26,"90th_percentile":12386.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11873.69,"10th_percentile":9401.47,"90th_percentile":15022.52,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16468.79,"10th_percentile":16468.79,"90th_percentile":16468.79,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":13061.05,"10th_percentile":13061.05,"90th_percentile":13061.05,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":35180.06,"10th_percentile":35180.06,"90th_percentile":35180.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":345.79,"10th_percentile":345.79,"90th_percentile":345.79,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17284.12,"maximum":33306.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33306.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26790.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23333.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15682.0,"10th_percentile":8390.0,"90th_percentile":22777.69,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12503.93,"10th_percentile":12386.26,"90th_percentile":15791.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"15","median_amount":9401.47,"10th_percentile":9401.47,"90th_percentile":11873.69,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12864.52,"10th_percentile":12864.52,"90th_percentile":12864.52,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13707.74,"10th_percentile":13707.74,"90th_percentile":13707.74,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":29979.22,"10th_percentile":29979.22,"90th_percentile":29979.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14069.74,"maximum":27112.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27112.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21808.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18994.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34209.46,"maximum":65921.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53024.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46182.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34209.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17736.98,"maximum":34179.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34179.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27492.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23944.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14402.23,"maximum":27753.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27753.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22323.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19443.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14402.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41568.61,"maximum":80102.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80102.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64431.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22180.68,"maximum":42742.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42742.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34380.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29943.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22180.68,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15396.73,"maximum":29669.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29669.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23864.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20785.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":109331.15,"maximum":210681.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":210681.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147597.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109331.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":71814.21,"maximum":138385.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":138385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111312.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96949.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71814.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":56061.95,"maximum":108031.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108031.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86896.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75683.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56061.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":89484.45,"maximum":172436.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":172436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138700.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120804.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89484.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":57493.53,"maximum":110790.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110790.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89114.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77616.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57493.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12972.79,"10th_percentile":12972.79,"90th_percentile":20065.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9753.99,"10th_percentile":8839.96,"90th_percentile":9753.99,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":95868.31,"10th_percentile":95868.31,"90th_percentile":95868.31},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20013.09,"maximum":38565.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38565.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31020.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27017.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20013.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7719.61,"10th_percentile":7719.61,"90th_percentile":7719.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5804.23,"10th_percentile":5567.02,"90th_percentile":6415.74,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":22674.08,"10th_percentile":22674.08,"90th_percentile":22674.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11015.18,"maximum":21226.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21226.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17073.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14870.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":7310.0,"10th_percentile":7310.0,"90th_percentile":7310.0,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7624.2,"maximum":14691.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14691.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11817.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10292.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8374.44,"10th_percentile":8374.44,"90th_percentile":8374.44,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":70500.22,"10th_percentile":70500.22,"90th_percentile":70500.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18715.7,"maximum":36065.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36065.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25266.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7116.73,"10th_percentile":7116.73,"90th_percentile":7116.73,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11754.16,"maximum":22650.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22650.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18218.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15868.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9013.35,"maximum":17368.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17368.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13970.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12168.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":26606.85,"10th_percentile":26606.85,"90th_percentile":26687.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9179.27,"10th_percentile":9179.27,"90th_percentile":9179.27,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16502.33,"10th_percentile":16502.33,"90th_percentile":16502.33,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16678.34,"maximum":32139.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25851.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22515.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":18891.0,"10th_percentile":18891.0,"90th_percentile":18891.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":38870.59,"10th_percentile":38870.59,"90th_percentile":38870.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7901.98,"10th_percentile":7901.98,"90th_percentile":7977.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4593.14,"10th_percentile":4490.59,"90th_percentile":5941.36,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":32241.45,"10th_percentile":32241.45,"90th_percentile":32241.45},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8893.97,"maximum":17138.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17138.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13785.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12006.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8893.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":31485.0,"10th_percentile":31485.0,"90th_percentile":31485.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":29960.0,"10th_percentile":29960.0,"90th_percentile":29960.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6108.86,"10th_percentile":5972.47,"90th_percentile":6108.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4593.14,"10th_percentile":4593.14,"90th_percentile":5941.36,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6458.24,"10th_percentile":6458.24,"90th_percentile":6458.24,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"1 through 10","median_amount":6303.95,"10th_percentile":6303.95,"90th_percentile":6303.95,"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":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6725.39,"maximum":12959.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12959.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10424.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9079.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8227.41,"10th_percentile":8227.41,"90th_percentile":8227.41,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18301.32,"maximum":35266.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35266.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28367.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24706.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":37290.0,"10th_percentile":37290.0,"90th_percentile":37290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8178.37,"10th_percentile":8178.37,"90th_percentile":8178.37,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10118.35,"maximum":19498.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19498.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15683.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13659.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7841.0,"10th_percentile":7841.0,"90th_percentile":7841.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7497.91,"maximum":14448.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14448.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11621.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10122.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13280.16,"10th_percentile":13280.16,"90th_percentile":13280.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4112.12,"10th_percentile":4112.12,"90th_percentile":4112.12,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17060.31,"10th_percentile":17060.31,"90th_percentile":17060.31,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":8051.54,"10th_percentile":8051.54,"90th_percentile":8051.54,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17079.89,"maximum":32912.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32912.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26473.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23057.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":15788.0,"10th_percentile":15788.0,"90th_percentile":15788.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7319.6,"10th_percentile":7319.6,"90th_percentile":7319.6,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10943.75,"10th_percentile":10943.75,"90th_percentile":10943.75,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11392.07,"maximum":21952.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21952.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17657.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15379.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":5689.0,"10th_percentile":5689.0,"90th_percentile":5689.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8170.43,"10th_percentile":8170.43,"90th_percentile":8170.43,"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":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":2293.08,"10th_percentile":2293.08,"90th_percentile":2293.08,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":6179.86,"10th_percentile":6179.86,"90th_percentile":6179.86,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6860.38,"10th_percentile":6860.38,"90th_percentile":6860.38,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":43053.94,"10th_percentile":43053.94,"90th_percentile":43053.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8756.83,"maximum":16874.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16874.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13573.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11821.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":66516.1,"maximum":128176.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128176.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103099.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66516.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42434.86,"maximum":81771.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81771.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57287.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":53177.1,"maximum":102472.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102472.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82424.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71789.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53177.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32466.12,"maximum":62562.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62562.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43829.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32466.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":83503.6,"maximum":160911.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":160911.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129430.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112729.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83503.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":59427.29,"maximum":114516.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114516.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92112.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80226.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59427.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41761.99,"maximum":80475.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80475.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56378.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41761.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":55085.2,"maximum":106149.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106149.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85382.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74365.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55085.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":9576.81,"10th_percentile":9576.81,"90th_percentile":9576.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26838.48,"maximum":51717.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51717.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41599.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36231.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":18562.71,"10th_percentile":18562.71,"90th_percentile":18562.71,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":56826.58,"maximum":109504.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109504.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88081.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76715.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56826.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31324.61,"maximum":60362.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60362.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48553.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42288.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31324.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18587.44,"maximum":35818.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28810.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25093.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":51951.72,"maximum":100110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100110.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80525.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70134.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51951.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":25170.0,"10th_percentile":25170.0,"90th_percentile":25170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35388.47,"maximum":68193.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68193.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54852.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47774.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35388.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13452.11,"10th_percentile":13452.11,"90th_percentile":13452.11,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24886.38,"10th_percentile":24886.38,"90th_percentile":24886.38,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27706.7,"maximum":53390.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53390.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37404.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12960.79,"10th_percentile":12960.79,"90th_percentile":12960.79,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30520.52,"maximum":58813.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58813.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47306.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41202.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30520.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12737.47,"10th_percentile":12206.0,"90th_percentile":12960.79,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18688.65,"10th_percentile":18688.65,"90th_percentile":18688.65,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18655.14,"10th_percentile":18655.14,"90th_percentile":18655.14,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19625.35,"maximum":37818.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37818.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30419.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26494.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19625.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":48235.15,"maximum":92949.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92949.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74764.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65117.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48235.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29661.18,"maximum":57157.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45974.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40042.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29661.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24680.76,"maximum":47559.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47559.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38255.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33319.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24680.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43678.17,"10th_percentile":43678.17,"90th_percentile":43678.17,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42948.88,"maximum":82762.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66570.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57980.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":24090.68,"10th_percentile":24090.68,"90th_percentile":24090.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23046.93,"maximum":44411.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44411.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35722.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31113.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23046.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12238.58,"maximum":23583.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23583.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18969.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16522.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34678.11,"maximum":66824.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53751.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46815.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34678.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24857.36,"maximum":47900.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47900.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38528.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33557.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24857.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18934.73,"maximum":36487.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36487.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29348.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25561.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28059.76,"10th_percentile":28059.76,"90th_percentile":28059.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":15906.0,"10th_percentile":15906.0,"90th_percentile":15906.0,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29327.7,"maximum":56514.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56514.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45457.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39592.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29327.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15964.54,"10th_percentile":15964.54,"90th_percentile":15964.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":18317.23,"10th_percentile":18317.23,"90th_percentile":18317.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12261.04,"10th_percentile":12261.04,"90th_percentile":12261.04,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19575.54,"10th_percentile":19575.54,"90th_percentile":19575.54,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21259.18,"maximum":40966.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40966.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32951.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28699.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14715.02,"10th_percentile":14715.02,"90th_percentile":14715.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":15434.19,"10th_percentile":15434.19,"90th_percentile":15434.19},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16686.23,"maximum":32154.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32154.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25863.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22526.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16686.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27154.04,"10th_percentile":27154.04,"90th_percentile":27154.04,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27942.5,"maximum":53845.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53845.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43310.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37722.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27942.5,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32433.56,"maximum":62499.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50272.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43785.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21225.64,"maximum":40901.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40901.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32899.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28654.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16046.91,"maximum":30922.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30922.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24872.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21663.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18046.77,"maximum":34776.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34776.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24363.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11613.07,"maximum":22378.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18000.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10430.58,"10th_percentile":10430.58,"90th_percentile":10430.58,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36819.06,"maximum":70950.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70950.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57069.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36819.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":15089.58,"10th_percentile":15089.58,"90th_percentile":15089.58,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":14864.47,"10th_percentile":14864.47,"90th_percentile":14864.47,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21644.71,"10th_percentile":21644.71,"90th_percentile":21644.71,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":351.16,"10th_percentile":351.16,"90th_percentile":351.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25616.07,"maximum":49362.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49362.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39704.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34581.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25616.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11702.54,"10th_percentile":11702.54,"90th_percentile":15089.58,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20390.97,"maximum":39293.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39293.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27527.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20390.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36366.2,"maximum":70077.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70077.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56367.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36366.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18392.09,"maximum":35441.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28507.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24829.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18392.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12515.82,"maximum":24117.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24117.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19399.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16896.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30358.71,"maximum":58501.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58501.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47056.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40984.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30358.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20472.85,"maximum":39451.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31732.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27638.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20472.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31818.9,"maximum":61315.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61315.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42955.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31818.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":13070.15,"10th_percentile":13070.15,"90th_percentile":13070.15},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17841.56,"maximum":34380.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34380.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13987.69,"10th_percentile":13987.69,"90th_percentile":13987.69,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13873.4,"maximum":26734.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26734.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21503.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18729.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28131.93,"maximum":54210.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54210.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43604.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37978.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28131.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13627.46,"10th_percentile":13627.46,"90th_percentile":17985.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19036.35,"maximum":36683.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36683.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29506.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25699.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18282.57,"maximum":35230.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35230.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28337.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24681.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13905.96,"maximum":26796.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26796.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21554.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18773.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18416.75,"maximum":35489.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35489.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28545.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24862.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15535.84,"maximum":29937.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29937.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24080.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20973.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30395.22,"maximum":58571.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58571.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47112.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41033.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30395.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21110.21,"maximum":40679.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40679.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32720.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28498.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16926.97,"maximum":32618.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32618.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26236.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22851.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16926.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16126.83,"maximum":31076.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31076.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24996.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21771.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16126.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7192.48,"10th_percentile":7192.48,"90th_percentile":7192.48,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10680.72,"maximum":20581.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20581.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16555.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14418.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32036.94,"maximum":61735.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49657.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43249.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17913.2,"10th_percentile":17913.2,"90th_percentile":17913.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":1632.0,"10th_percentile":1632.0,"90th_percentile":1632.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21097.38,"maximum":40654.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40654.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32700.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28481.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15755.86,"maximum":30361.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30361.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24421.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21270.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37467.26,"maximum":72199.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58074.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20328.81,"maximum":39173.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39173.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31509.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27443.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20328.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15333.59,"maximum":29547.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29547.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23767.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20700.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28912.34,"maximum":55714.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55714.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44814.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39031.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20881.36,"10th_percentile":20881.36,"90th_percentile":20881.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21488.08,"maximum":41407.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41407.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33306.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29008.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21488.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16061.71,"maximum":30950.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30950.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24895.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21683.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5907.91,"10th_percentile":5907.91,"90th_percentile":5907.91,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8547.67,"maximum":16471.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16471.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13248.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13311.27,"10th_percentile":13311.27,"90th_percentile":13311.27,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13242.96,"maximum":25519.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20526.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17878.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5448.58,"10th_percentile":5448.58,"90th_percentile":5448.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5488.15,"10th_percentile":5488.15,"90th_percentile":5488.15,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":345.79,"10th_percentile":345.79,"90th_percentile":345.79,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8562.46,"maximum":16499.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16499.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13271.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11559.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10009.83,"maximum":19288.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19288.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7701.15,"maximum":14840.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14840.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11936.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10396.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20027.89,"maximum":38593.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38593.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31043.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27037.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12368.57,"10th_percentile":12368.57,"90th_percentile":12368.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9701.76,"10th_percentile":9701.76,"90th_percentile":9701.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13384.04,"maximum":25791.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25791.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18068.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8363.17,"maximum":16115.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16115.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12962.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11290.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18023.1,"maximum":34730.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34730.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27935.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24331.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6180.85,"10th_percentile":6180.85,"90th_percentile":6180.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":344.79,"10th_percentile":344.79,"90th_percentile":344.79,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10736.96,"maximum":20690.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20690.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16642.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14494.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8039.56,"maximum":15492.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15492.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12461.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25079.35,"maximum":48327.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48327.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38872.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33857.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25079.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11974.17,"maximum":23074.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23074.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18559.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16165.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8844.64,"maximum":17043.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17043.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13709.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11940.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19645.09,"maximum":37856.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37856.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30449.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26520.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9701.76,"10th_percentile":9701.76,"90th_percentile":9701.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6231.91,"10th_percentile":6231.91,"90th_percentile":6231.91,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12504.97,"maximum":24097.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24097.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19382.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16881.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9218.56,"maximum":17764.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17764.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14288.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12445.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":16780.0,"10th_percentile":16780.0,"90th_percentile":16780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16470.77,"10th_percentile":16470.77,"90th_percentile":16470.77,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15145.77,"10th_percentile":15145.77,"90th_percentile":15145.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11994.09,"10th_percentile":11994.09,"90th_percentile":11994.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11217.29,"10th_percentile":11217.29,"90th_percentile":11217.29,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17131.2,"maximum":33011.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33011.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26553.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23127.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":31485.0,"10th_percentile":31485.0,"90th_percentile":31485.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9797.0,"10th_percentile":9797.0,"90th_percentile":9797.0,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"1 through 10","median_amount":10728.0,"10th_percentile":10728.0,"90th_percentile":10728.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6640.78,"10th_percentile":6640.78,"90th_percentile":6640.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5186.68,"10th_percentile":5186.68,"90th_percentile":6571.92,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9554.24,"10th_percentile":9554.24,"90th_percentile":9554.24,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5247.72,"10th_percentile":5247.72,"90th_percentile":5247.72,"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":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10078.89,"maximum":19422.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19422.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15622.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13606.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13384.04,"maximum":25791.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25791.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18068.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8537.9,"10th_percentile":8537.9,"90th_percentile":8537.9,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8784.45,"maximum":16927.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16927.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11859.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13635.63,"maximum":26275.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26275.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21135.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18408.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4215.8,"10th_percentile":4215.8,"90th_percentile":4215.8,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8789.39,"maximum":16937.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16937.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13623.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11865.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":16780.0,"10th_percentile":16780.0,"90th_percentile":16780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14319.82,"10th_percentile":14319.82,"90th_percentile":14319.82,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15264.53,"maximum":29414.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29414.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23660.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20607.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":13814.0,"10th_percentile":13814.0,"90th_percentile":13814.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9701.76,"10th_percentile":9701.76,"90th_percentile":9701.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":7022.86,"10th_percentile":7022.86,"90th_percentile":7022.86},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9407.01,"maximum":18127.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14580.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12699.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.01,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":8390.0,"10th_percentile":8390.0,"90th_percentile":8390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18993.92,"maximum":36601.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36601.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29440.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25641.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18993.92,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6559.46,"10th_percentile":6559.46,"90th_percentile":6559.46,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11704.83,"maximum":22555.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22555.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18142.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15801.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11704.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8525.96,"maximum":16429.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16429.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13215.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11510.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7375.85,"10th_percentile":7375.85,"90th_percentile":7375.85,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14651.84,"maximum":28234.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22710.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19779.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":31485.0,"10th_percentile":31485.0,"90th_percentile":31485.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8865.77,"10th_percentile":8865.77,"90th_percentile":8865.77,"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":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":22470.0,"10th_percentile":22470.0,"90th_percentile":22470.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5746.89,"10th_percentile":5746.89,"90th_percentile":5746.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8367.54,"10th_percentile":8367.54,"90th_percentile":8367.54,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9199.81,"10th_percentile":9199.81,"90th_percentile":9199.81,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9156.84,"10th_percentile":9156.84,"90th_percentile":9166.3,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9429.7,"maximum":18171.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14616.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12730.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":55395.0,"10th_percentile":55395.0,"90th_percentile":55395.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9306.62,"10th_percentile":9306.62,"90th_percentile":9306.62,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13586.35,"10th_percentile":13586.35,"90th_percentile":13586.35,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15823.94,"maximum":30492.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30492.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24527.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21362.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12394.78,"10th_percentile":12394.78,"90th_percentile":12394.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9787.11,"10th_percentile":9787.11,"90th_percentile":9787.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6436.94,"10th_percentile":6436.94,"90th_percentile":6436.94,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10208.14,"maximum":19671.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19671.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15822.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13780.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7987.27,"maximum":15391.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15391.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12380.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10782.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29611.85,"maximum":57062.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57062.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45898.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39976.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17263.4,"maximum":33266.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33266.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26758.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23305.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17263.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11904.12,"maximum":22939.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22939.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16070.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":65231.53,"maximum":125701.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125701.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101108.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65231.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34843.86,"maximum":67144.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67144.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54007.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47039.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34843.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18324.01,"maximum":35310.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35310.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28402.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24737.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.01,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":48950.45,"maximum":94327.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94327.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75873.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48950.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26746.73,"maximum":51540.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51540.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41457.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36108.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16443.53,"maximum":31686.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31686.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25487.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22198.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32546.04,"maximum":62716.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62716.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50446.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43937.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32546.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":52430.0,"10th_percentile":52430.0,"90th_percentile":52430.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17643.25,"maximum":33998.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33998.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27347.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23818.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14832.39,"maximum":28582.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28582.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22990.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20023.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19602.66,"maximum":37774.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37774.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26463.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17607.73,"maximum":33930.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33930.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27291.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23770.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21715.0,"maximum":41844.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41844.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33658.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29315.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19627.33,"maximum":37821.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37821.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30422.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26496.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19688.5,"maximum":37939.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37939.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30517.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26579.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19688.5,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11957.09,"10th_percentile":11957.09,"90th_percentile":11957.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12298.77,"maximum":23699.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23699.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19063.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16603.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9146.54,"maximum":17625.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17625.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12347.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21517.68,"maximum":41464.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41464.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29048.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11274.66,"maximum":21726.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21726.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17475.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15220.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17042.4,"maximum":32840.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32840.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26415.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23007.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17042.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11756.13,"maximum":22654.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18222.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15870.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8185.58,"maximum":15773.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15773.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12687.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11050.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10871.14,"maximum":20948.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20948.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16850.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14676.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6563.59,"maximum":12648.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12648.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10173.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8860.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7801.03,"10th_percentile":7801.03,"90th_percentile":7801.03,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14617.31,"maximum":28167.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28167.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19733.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7304.6,"10th_percentile":7304.6,"90th_percentile":28444.31,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8982.67,"10th_percentile":8982.67,"90th_percentile":8982.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5055.89,"10th_percentile":5055.89,"90th_percentile":6887.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"15","median_amount":5178.67,"10th_percentile":3801.43,"90th_percentile":6908.1,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":8504.44,"10th_percentile":8504.44,"90th_percentile":8504.44,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":8922.58,"10th_percentile":8922.58,"90th_percentile":8922.58},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":7094.83,"10th_percentile":7094.83,"90th_percentile":8534.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8199.18,"10th_percentile":8199.18,"90th_percentile":8199.18,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9186.99,"maximum":17703.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17703.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14239.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12402.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9186.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15118.51,"maximum":29133.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29133.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23433.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20409.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8395.56,"10th_percentile":8395.56,"90th_percentile":8395.56,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9395.69,"10th_percentile":9395.69,"90th_percentile":9395.69,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9631.95,"maximum":18560.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18560.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14929.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13003.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15524.0,"maximum":29914.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29914.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24062.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20957.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4974.49,"10th_percentile":4974.49,"90th_percentile":4974.49,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9537.24,"maximum":18378.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14782.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12875.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22219.16,"maximum":42816.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34439.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29995.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14400.25,"maximum":27749.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22320.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19440.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35001.71,"maximum":67448.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54252.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35001.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":91321.67,"10th_percentile":91321.67,"90th_percentile":91321.67,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":17985.8,"10th_percentile":17985.8,"90th_percentile":17985.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19047.2,"maximum":36703.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29523.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19047.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14587.71,"maximum":28110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28110.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22610.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19693.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29082.04,"maximum":56041.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56041.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45077.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39260.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29082.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11328.2,"10th_percentile":11328.2,"90th_percentile":11328.2,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16383.34,"maximum":31570.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31570.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25394.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22117.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":26404.0,"10th_percentile":26404.0,"90th_percentile":26404.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":124624.72,"10th_percentile":124624.72,"90th_percentile":124624.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"19","median_amount":9872.89,"10th_percentile":9872.89,"90th_percentile":9872.89,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15476.65,"maximum":29823.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29823.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23988.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20893.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":41950.0,"10th_percentile":41950.0,"90th_percentile":41950.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35710.1,"maximum":68813.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68813.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55350.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":31364.0,"10th_percentile":31364.0,"90th_percentile":31364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8993.1,"10th_percentile":8488.23,"90th_percentile":12897.61,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18293.43,"maximum":35251.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35251.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28354.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24696.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12945.99,"maximum":24946.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24946.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20066.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30391.27,"maximum":58563.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58563.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47106.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41028.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15387.85,"maximum":29652.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23851.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20773.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13699.76,"maximum":26399.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26399.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21234.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18494.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37363.67,"maximum":71999.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71999.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50440.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37363.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22155.58,"10th_percentile":22155.58,"90th_percentile":22155.58,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22090.9,"maximum":42569.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42569.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34240.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29822.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22090.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14994.19,"maximum":28893.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28893.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20242.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14994.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14512.82,"10th_percentile":14512.82,"90th_percentile":14512.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7245.53,"10th_percentile":5392.74,"90th_percentile":15099.59,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5392.73,"10th_percentile":5392.73,"90th_percentile":5392.73,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14646.75,"10th_percentile":14646.75,"90th_percentile":14646.75,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":5360.72,"10th_percentile":5360.72,"90th_percentile":5360.72,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16701.6,"10th_percentile":16701.6,"90th_percentile":16701.6,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13687.74,"10th_percentile":13687.74,"90th_percentile":13687.74,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14769.25,"maximum":28460.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28460.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22892.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19938.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":9199.0,"10th_percentile":9199.0,"90th_percentile":17105.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":411.31,"10th_percentile":411.31,"90th_percentile":411.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7172.33,"10th_percentile":6481.6,"90th_percentile":9701.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"12","median_amount":4873.4,"10th_percentile":4873.4,"90th_percentile":7453.56,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13573.06,"10th_percentile":13573.06,"90th_percentile":13573.06,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9084.71,"10th_percentile":9084.71,"90th_percentile":9102.41,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9436.6,"maximum":18184.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18184.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14626.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12739.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":6618.58,"10th_percentile":6618.58,"90th_percentile":6618.58,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6481.6,"10th_percentile":6481.6,"90th_percentile":6481.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":31514.06,"10th_percentile":31514.06,"90th_percentile":31514.06,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4873.4,"10th_percentile":4873.4,"90th_percentile":4873.4,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":8302.08,"10th_percentile":8302.08,"90th_percentile":8302.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6723.42,"maximum":12956.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12956.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9076.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6723.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9132.14,"10th_percentile":9132.14,"90th_percentile":9132.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6507.87,"10th_percentile":6507.87,"90th_percentile":6507.87,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13192.16,"10th_percentile":13192.16,"90th_percentile":13192.16,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":7158.64,"10th_percentile":7158.64,"90th_percentile":7158.64,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10347.41,"10th_percentile":10347.41,"90th_percentile":10347.41,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":16012.91,"10th_percentile":16012.91,"90th_percentile":16012.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13771.78,"maximum":26538.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26538.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21346.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18591.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8049.04,"10th_percentile":8049.04,"90th_percentile":8049.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":5167.06,"10th_percentile":5167.06,"90th_percentile":5167.06,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6171.63,"10th_percentile":6171.63,"90th_percentile":6171.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":24249.0,"10th_percentile":24249.0,"90th_percentile":24249.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7087.29,"10th_percentile":7087.29,"90th_percentile":7087.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5296.27,"10th_percentile":4403.97,"90th_percentile":5328.81,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8025.73,"10th_percentile":8025.73,"90th_percentile":8025.73,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":32116.48,"10th_percentile":32116.48,"90th_percentile":32116.48},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":7731.13,"10th_percentile":7731.13,"90th_percentile":7731.13},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6126.72,"10th_percentile":6126.72,"90th_percentile":6126.72,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8272.4,"maximum":15940.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15940.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12822.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":24072.05,"10th_percentile":24072.05,"90th_percentile":24072.05,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14625.2,"maximum":28182.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22669.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19744.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.2,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":15024.09,"10th_percentile":15024.09,"90th_percentile":15024.09},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16835.21,"maximum":32441.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32441.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22727.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16835.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10461.79,"10th_percentile":10461.79,"90th_percentile":10461.79,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5323.91,"10th_percentile":5323.91,"90th_percentile":5323.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10485.31,"10th_percentile":10485.31,"90th_percentile":10485.31,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10707.36,"maximum":20633.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20633.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16596.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14454.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8033.25,"10th_percentile":8033.25,"90th_percentile":8033.25,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8174.73,"maximum":15752.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15752.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12670.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46979.19,"maximum":90528.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90528.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72817.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63421.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46979.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37156.48,"maximum":71600.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71600.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57592.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50161.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37156.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32457.24,"maximum":62545.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62545.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50308.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43817.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":51862.93,"maximum":99939.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99939.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80387.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51862.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28212.83,"maximum":54366.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54366.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43729.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38087.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28212.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21477.23,"maximum":41386.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41386.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33289.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21477.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32006.36,"maximum":61676.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61676.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49609.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43208.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18649.59,"maximum":35937.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35937.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28906.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25176.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15904.84,"maximum":30648.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30648.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24652.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21471.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12682.35,"10th_percentile":12682.35,"90th_percentile":12682.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25663.42,"maximum":49453.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49453.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39778.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34645.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25663.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":31364.0,"10th_percentile":31364.0,"90th_percentile":31364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11706.54,"10th_percentile":11706.54,"90th_percentile":11706.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13634.64,"maximum":26273.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26273.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21133.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18406.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":20721.0,"10th_percentile":20721.0,"90th_percentile":20721.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":24562.35,"10th_percentile":24562.35,"90th_percentile":24562.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10809.97,"maximum":20830.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16755.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14593.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30799.73,"maximum":59351.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59351.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47739.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41579.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15593.07,"maximum":30047.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30047.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21050.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15593.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10923.43,"maximum":21049.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21049.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16931.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14746.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31388.74,"maximum":60486.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60486.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48652.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42374.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31388.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17853.4,"maximum":34403.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34403.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27672.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24102.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11508.49,"maximum":22176.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22176.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17838.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15536.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29403.67,"maximum":56660.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56660.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45575.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39694.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29403.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9641.86,"10th_percentile":9641.86,"90th_percentile":9641.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15906.81,"maximum":30652.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30652.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24655.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21474.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15906.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10236.75,"maximum":19726.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19726.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15866.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13819.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18304.28,"maximum":35272.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35272.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28371.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24710.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11245.07,"maximum":21669.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21669.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17429.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15180.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":101933.0,"10th_percentile":101933.0,"90th_percentile":101933.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":17352.62,"10th_percentile":17352.62,"90th_percentile":17352.62,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21959.41,"10th_percentile":21959.41,"90th_percentile":21959.41,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42048.1,"maximum":81026.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81026.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65174.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42048.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":17352.62,"10th_percentile":17352.62,"90th_percentile":17352.62,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23667.51,"maximum":45607.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45607.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36684.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31951.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16788.84,"maximum":32352.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32352.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26022.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22664.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":18891.0,"10th_percentile":18891.0,"90th_percentile":18891.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11111.5,"10th_percentile":11111.5,"90th_percentile":11111.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10117.38,"10th_percentile":10117.38,"90th_percentile":10117.38,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":89924.54,"10th_percentile":89924.54,"90th_percentile":89924.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15206.32,"maximum":29302.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29302.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23569.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20528.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15682.0,"10th_percentile":15682.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8819.93,"10th_percentile":8819.93,"90th_percentile":8819.93,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5463.77,"10th_percentile":5463.77,"90th_percentile":8886.83,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9094.19,"10th_percentile":9094.19,"90th_percentile":9094.19,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9245.58,"10th_percentile":9245.58,"90th_percentile":9245.58,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":9189.96,"10th_percentile":9189.96,"90th_percentile":9189.96,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9094.19,"10th_percentile":9094.19,"90th_percentile":9094.19,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":8999.85,"10th_percentile":8999.85,"90th_percentile":8999.85},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":2509.25,"10th_percentile":2509.25,"90th_percentile":2509.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9235.33,"maximum":17796.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14314.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6517.22,"maximum":12558.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12558.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10101.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18390.11,"maximum":35437.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35437.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28504.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24826.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":15878.0,"10th_percentile":15878.0,"90th_percentile":15878.0,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10932.31,"maximum":21066.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21066.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16945.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14758.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10932.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8391.78,"maximum":16170.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16170.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13007.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11470.81,"10th_percentile":11470.81,"90th_percentile":11470.81,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11377.76,"10th_percentile":11377.76,"90th_percentile":11377.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9416.95,"10th_percentile":9416.95,"90th_percentile":9416.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5169.66,"10th_percentile":5169.66,"90th_percentile":5169.66,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9152.88,"10th_percentile":9152.88,"90th_percentile":9152.88,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12042.25,"maximum":23205.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23205.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18665.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16257.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":7925.98,"10th_percentile":7925.98,"90th_percentile":18891.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7841.0,"10th_percentile":7841.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8022.46,"10th_percentile":8022.46,"90th_percentile":8022.46,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":6907.0,"10th_percentile":6907.0,"90th_percentile":6907.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8229.81,"10th_percentile":6870.65,"90th_percentile":8237.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":69657.39,"10th_percentile":69657.39,"90th_percentile":69657.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6875.63,"10th_percentile":6875.63,"90th_percentile":7847.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5169.66,"10th_percentile":4149.75,"90th_percentile":6462.07,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8263.33,"10th_percentile":8045.98,"90th_percentile":8263.33,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8512.19,"10th_percentile":8512.19,"90th_percentile":8512.19,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":7672.8,"10th_percentile":7672.8,"90th_percentile":7672.8,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8221.39,"10th_percentile":6495.21,"90th_percentile":8229.82,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8581.21,"maximum":16535.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16535.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13300.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11584.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13859.59,"maximum":26707.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26707.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21482.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18710.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7971.77,"10th_percentile":7971.77,"90th_percentile":7971.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5341.82,"10th_percentile":5341.82,"90th_percentile":5993.82,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8025.73,"10th_percentile":8025.73,"90th_percentile":8025.73,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":5198.52,"10th_percentile":5198.52,"90th_percentile":5198.52,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":7936.39,"10th_percentile":7936.39,"90th_percentile":7936.39},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8306.93,"maximum":16007.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16007.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12875.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11214.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11879.46,"maximum":22891.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22891.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18413.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16037.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5288.85,"10th_percentile":5288.85,"90th_percentile":5288.85,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7009.31,"10th_percentile":7009.31,"90th_percentile":7009.31,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7392.34,"maximum":14245.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14245.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11458.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9979.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11228.29,"maximum":21636.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21636.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15158.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":15682.0,"10th_percentile":15682.0,"90th_percentile":15682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":148.39,"10th_percentile":148.39,"90th_percentile":148.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11433.15,"10th_percentile":7681.31,"90th_percentile":16359.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7469.73,"10th_percentile":7469.73,"90th_percentile":14814.91,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13641.91,"10th_percentile":13641.91,"90th_percentile":13641.91,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12300.06,"10th_percentile":12300.06,"90th_percentile":12300.06,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7386.6,"10th_percentile":7386.6,"90th_percentile":16776.04,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19210.22,"10th_percentile":19210.22,"90th_percentile":19210.22,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16230.99,"10th_percentile":16230.99,"90th_percentile":16230.99,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16917.1,"maximum":32599.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22838.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16917.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10050.61,"10th_percentile":10050.61,"90th_percentile":10050.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7043.36,"10th_percentile":7043.36,"90th_percentile":7043.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5295.78,"10th_percentile":5295.78,"90th_percentile":7469.73,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10608.7,"maximum":20442.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20442.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14321.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7225.74,"10th_percentile":7225.74,"90th_percentile":7225.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5295.78,"10th_percentile":5295.78,"90th_percentile":5295.78,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7186.25,"10th_percentile":7186.25,"90th_percentile":7186.25,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":1676.0,"10th_percentile":1676.0,"90th_percentile":1676.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7401.22,"maximum":14262.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14262.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9991.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20329.8,"maximum":39175.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39175.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31511.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27445.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20329.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15731.19,"maximum":30314.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30314.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21237.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23554.05,"maximum":45388.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45388.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36508.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31797.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23554.05,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14419.0,"maximum":27785.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27785.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22349.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19465.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21153.62,"maximum":40763.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40763.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32788.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28557.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9843.87,"10th_percentile":9843.87,"90th_percentile":9843.87,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11444.36,"maximum":22053.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22053.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17738.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15449.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15427.32,"maximum":29728.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23912.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20826.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15427.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":3669.24,"10th_percentile":3669.24,"90th_percentile":3669.24,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11027.02,"maximum":21249.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21249.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17091.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14886.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.02,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22668.07,"maximum":43681.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43681.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35135.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30601.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22668.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15107.65,"maximum":29112.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29112.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23416.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20395.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19246.49,"maximum":37087.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37087.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29832.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25982.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19246.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13845.78,"maximum":26680.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26680.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21460.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18691.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18449.31,"maximum":35551.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35551.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28596.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24906.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11868.6,"maximum":22870.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22870.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16022.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7063.8,"maximum":13611.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13611.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9536.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12139.92,"maximum":23393.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23393.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18816.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16388.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.92,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7717.92,"maximum":14872.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11962.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10419.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.92,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15225.06,"maximum":29338.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29338.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23598.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20553.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":6272.81,"10th_percentile":6272.81,"90th_percentile":6272.81,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3980.59,"10th_percentile":3980.59,"90th_percentile":3980.59,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":344.79,"10th_percentile":344.79,"90th_percentile":344.79,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8597.98,"maximum":16568.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13326.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11607.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11039.85,"maximum":21273.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21273.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17111.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14903.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7224.62,"maximum":13921.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13921.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11198.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9753.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21609.43,"maximum":41641.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41641.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33494.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29172.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13869.46,"maximum":26726.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26726.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21497.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18723.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35861.05,"maximum":69104.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55584.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48412.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35861.05,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20924.72,"maximum":40321.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32433.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28248.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20924.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15082.99,"maximum":29064.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29064.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23378.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20362.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35942.94,"maximum":69262.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69262.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55711.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48522.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35942.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18448.33,"maximum":35549.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35549.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28594.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24905.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18448.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14664.67,"maximum":28258.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28258.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22730.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19797.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18696.95,"maximum":36029.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36029.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28980.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":2790.0,"10th_percentile":2790.0,"90th_percentile":2790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8452.61,"10th_percentile":8452.61,"90th_percentile":8452.61,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":27562.76,"10th_percentile":27562.76,"90th_percentile":27562.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12835.48,"maximum":24733.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24733.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19894.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17327.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20811.26,"maximum":40103.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40103.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32257.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28095.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20811.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":16780.0,"10th_percentile":16780.0,"90th_percentile":16780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11817.3,"maximum":22771.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22771.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18316.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15953.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11817.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17733.03,"maximum":34171.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34171.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27486.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23939.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9076.49,"maximum":17490.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17490.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14068.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12253.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14281.86,"maximum":27521.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27521.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22136.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19280.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14281.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7214.62,"10th_percentile":7214.62,"90th_percentile":7214.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25926.85,"maximum":49961.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49961.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40186.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25926.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15155.01,"maximum":29203.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29203.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20459.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.01,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18765.03,"maximum":36160.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36160.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29085.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25332.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.03,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11326.95,"maximum":21827.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21827.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10071.0,"maximum":19406.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19406.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15610.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13595.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14721.89,"maximum":28369.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28369.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22818.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19874.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14721.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10253.52,"maximum":19758.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19758.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15892.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13842.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7141.74,"maximum":13762.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13762.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11069.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9641.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5941.14,"10th_percentile":5941.14,"90th_percentile":5941.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":12790.47,"10th_percentile":12790.47,"90th_percentile":12790.47,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6928.24,"10th_percentile":6928.24,"90th_percentile":6928.24,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10534.7,"maximum":20300.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20300.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16328.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14221.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4709.77,"10th_percentile":4709.77,"90th_percentile":4709.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6223.21,"maximum":11992.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11992.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9645.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8401.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11167.12,"maximum":21519.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21519.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15075.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17266.36,"maximum":33272.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33272.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26762.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23309.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10487.35,"maximum":20209.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20209.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16255.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14157.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":7531.0,"10th_percentile":7531.0,"90th_percentile":7531.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7053.93,"maximum":13592.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13592.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10933.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9522.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8894.95,"maximum":17140.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17140.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13787.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12008.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24816.91,"maximum":47822.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47822.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38466.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33502.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11053.66,"maximum":21300.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21300.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17133.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14922.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10044.36,"maximum":19355.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19355.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15568.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16868.76,"maximum":32506.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32506.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26146.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22772.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16868.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11613.07,"maximum":22378.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18000.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10054.22,"maximum":19374.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19374.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15584.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13573.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18375.32,"maximum":35409.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35409.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28481.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24806.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":59233.91,"maximum":114143.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114143.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91812.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79965.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59233.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":40641.19,"maximum":78315.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78315.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62993.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54865.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40641.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24758.7,"maximum":47710.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47710.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38375.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33424.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41732.39,"maximum":80418.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80418.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64685.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41732.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15156.0,"maximum":29205.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29205.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23491.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20460.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":2565.83,"maximum":4944.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4944.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3977.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3463.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2565.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12108.35,"maximum":23332.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23332.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18767.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16346.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10464.65,"maximum":20165.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20165.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16220.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10037.45,"maximum":19342.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19342.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15558.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13550.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45277.29,"maximum":87249.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70179.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61124.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45277.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28312.48,"maximum":54558.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54558.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43884.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38221.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19428.03,"maximum":37437.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37437.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30113.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.03,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":39902.22,"maximum":76891.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76891.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61848.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39902.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18934.73,"maximum":36487.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36487.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29348.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25561.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13973.05,"maximum":26926.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26926.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21658.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18863.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.05,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11242.11,"maximum":21663.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21663.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17425.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15176.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8033.64,"maximum":15480.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12452.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10845.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7246.32,"maximum":13963.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13963.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11231.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9782.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22378.0,"maximum":43122.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43122.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34685.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30210.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22378.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12426.33,"10th_percentile":12426.33,"90th_percentile":12426.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13084.11,"maximum":25213.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20280.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17663.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7096.61,"10th_percentile":7096.61,"90th_percentile":7096.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10920.47,"maximum":21043.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21043.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16926.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14742.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13600.42,"10th_percentile":13600.42,"90th_percentile":13600.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5483.23,"10th_percentile":5483.23,"90th_percentile":5483.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14449.58,"maximum":27844.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27844.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22396.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19506.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7541.0,"10th_percentile":7541.0,"90th_percentile":7541.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7490.0,"10th_percentile":7490.0,"90th_percentile":7490.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7928.61,"10th_percentile":7928.61,"90th_percentile":7928.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4505.44,"10th_percentile":4156.75,"90th_percentile":5961.37,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10216.04,"10th_percentile":10216.04,"90th_percentile":10216.04,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9653.66,"maximum":18602.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18602.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14963.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13032.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.66,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7714.36,"10th_percentile":7714.36,"90th_percentile":7714.36,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15643.38,"maximum":30144.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30144.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24247.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21118.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15643.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21576.87,"maximum":41578.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33444.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21576.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":1076.8,"10th_percentile":1076.8,"90th_percentile":1076.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10598.83,"maximum":20423.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20423.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16428.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14308.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6829.97,"maximum":13161.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10586.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9220.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23105.14,"maximum":44523.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44523.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35812.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31191.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23105.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12031.4,"maximum":23184.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23184.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18648.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16242.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5504.95,"10th_percentile":5504.95,"90th_percentile":5504.95,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9078.46,"maximum":17494.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17494.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12255.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":58457.45,"maximum":112647.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112647.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90609.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78917.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58457.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22680.89,"maximum":43706.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43706.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35155.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30619.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22680.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12473.4,"maximum":24036.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24036.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19333.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45828.8,"maximum":88312.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88312.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71034.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61868.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45828.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":21093.47,"10th_percentile":21093.47,"90th_percentile":21093.47,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22947.28,"maximum":44219.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44219.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35568.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30978.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22947.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13907.93,"maximum":26800.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26800.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21557.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18775.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.93,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46746.35,"maximum":90080.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90080.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72456.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46746.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23397.17,"maximum":45086.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45086.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36265.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31586.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23397.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17404.49,"maximum":33538.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33538.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26976.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23496.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31771.54,"maximum":61223.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61223.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49245.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42891.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31771.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15443.1,"maximum":29758.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29758.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23936.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20848.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15443.1,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4320.04,"10th_percentile":4320.04,"90th_percentile":4320.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12458.6,"maximum":24007.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24007.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19310.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16819.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12458.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":1402.6,"10th_percentile":1402.6,"90th_percentile":1402.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3248.79,"10th_percentile":3248.79,"90th_percentile":3248.79,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7713.98,"maximum":14864.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14864.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11956.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10413.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3015.84,"10th_percentile":3015.84,"90th_percentile":3015.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":2926.63,"10th_percentile":2926.63,"90th_percentile":2926.63,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5753.58,"maximum":11087.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11087.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7767.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5753.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":54758.64,"maximum":105519.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105519.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84875.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73924.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54758.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21173.35,"maximum":40801.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40801.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32818.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28584.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21173.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12626.32,"maximum":24330.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24330.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19570.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17045.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12626.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":47994.42,"maximum":92485.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92485.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74391.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64792.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47994.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21189.14,"maximum":40831.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40831.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32843.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21189.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14840.28,"maximum":28597.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28597.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23002.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20034.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13260.42,"10th_percentile":13260.42,"90th_percentile":13260.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32510.52,"maximum":62647.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62647.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50391.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43889.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32510.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16690.18,"maximum":32161.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32161.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22531.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7200.21,"10th_percentile":7200.21,"90th_percentile":7200.21,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10563.32,"maximum":20355.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20355.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16373.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14260.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10563.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20275.53,"maximum":39070.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39070.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31427.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27371.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11701.12,"10th_percentile":11701.12,"90th_percentile":11701.12,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12605.6,"maximum":24290.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19538.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17017.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8996.57,"maximum":17336.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17336.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13944.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12145.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26172.52,"maximum":50434.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50434.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40567.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35332.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13501.45,"maximum":26017.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26017.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20927.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18226.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8974.87,"maximum":17294.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17294.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13911.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12116.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27326.85,"maximum":52658.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52658.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42356.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36891.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":86030.31,"maximum":165780.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":165780.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133346.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116140.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86030.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47948.4,"10th_percentile":47948.4,"90th_percentile":47948.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48685.11,"10th_percentile":48685.11,"90th_percentile":48685.11,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":30904.32,"10th_percentile":27691.56,"90th_percentile":49681.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":23879.96,"10th_percentile":23879.96,"90th_percentile":23879.96,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":20820.74,"10th_percentile":20820.74,"90th_percentile":20820.74,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48262.37,"10th_percentile":48262.37,"90th_percentile":48262.37,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":10479.23,"10th_percentile":10479.23,"90th_percentile":10479.23,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48651.59,"10th_percentile":48651.59,"90th_percentile":48651.59,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":49319.44,"maximum":95038.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95038.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76445.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66581.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":25170.0,"10th_percentile":25170.0,"90th_percentile":25170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":13814.0,"10th_percentile":13814.0,"90th_percentile":13814.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":24079.17,"10th_percentile":24079.17,"90th_percentile":24079.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":27691.56,"10th_percentile":27691.56,"90th_percentile":27691.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12678.41,"10th_percentile":12678.41,"90th_percentile":23236.34,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19739.16,"10th_percentile":19739.16,"90th_percentile":19739.16,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30424.49,"10th_percentile":30424.49,"90th_percentile":30424.49,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11279.04,"10th_percentile":11279.04,"90th_percentile":11279.04,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20308.09,"maximum":39133.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39133.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31477.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.09,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15366.15,"maximum":29610.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29610.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23817.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20744.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":19274.35,"10th_percentile":19274.35,"90th_percentile":19274.35,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":45472.64,"maximum":87625.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70482.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45472.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21722.89,"maximum":41860.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41860.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33670.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29325.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21722.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14337.11,"maximum":27627.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27627.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22222.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19355.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":13403.82,"10th_percentile":13403.82,"90th_percentile":13403.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11017.62,"10th_percentile":11017.62,"90th_percentile":11017.62,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18204.59,"10th_percentile":18204.59,"90th_percentile":18204.59,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18587.44,"maximum":35818.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28810.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25093.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":16166.0,"10th_percentile":16166.0,"90th_percentile":16166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8519.66,"10th_percentile":8519.66,"90th_percentile":8519.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6405.77,"10th_percentile":6405.77,"90th_percentile":6405.77,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10439.99,"maximum":20117.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16181.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14093.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10439.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9352.74,"maximum":18022.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14496.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12626.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":1971.28,"10th_percentile":1971.28,"90th_percentile":1971.28,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15377.0,"maximum":29631.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29631.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23834.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20758.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9174.16,"maximum":17678.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17678.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14219.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12385.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21246.36,"maximum":40941.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40941.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32931.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28682.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21246.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10767.54,"maximum":20749.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20749.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7793.89,"maximum":15018.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15018.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12080.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10521.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":62970.0,"10th_percentile":62970.0,"90th_percentile":62970.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":11235.66,"10th_percentile":11235.66,"90th_percentile":11235.66,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52404.13,"10th_percentile":52404.13,"90th_percentile":66929.31,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":68787.28,"maximum":132553.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132553.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106620.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92862.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68787.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":18891.0,"10th_percentile":18891.0,"90th_percentile":18891.0,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18861.19,"10th_percentile":9893.59,"90th_percentile":18892.49,"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":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":26623.0,"10th_percentile":26623.0,"90th_percentile":26623.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18894.71,"10th_percentile":18894.71,"90th_percentile":19402.57,"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":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"1 through 10","median_amount":9733.0,"10th_percentile":9733.0,"90th_percentile":9733.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":7458.0,"10th_percentile":7458.0,"90th_percentile":245547.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19788.34,"10th_percentile":19788.34,"90th_percentile":19788.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":15788.0,"10th_percentile":9022.0,"90th_percentile":47905.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"11","median_amount":12670.34,"10th_percentile":8481.05,"90th_percentile":23212.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":30037.22,"10th_percentile":30037.22,"90th_percentile":30037.22,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"42","median_amount":9526.58,"10th_percentile":6376.75,"90th_percentile":17452.71,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15522.23,"10th_percentile":8213.74,"90th_percentile":44897.02,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":30124.0,"10th_percentile":16458.0,"90th_percentile":73010.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":37882.88,"10th_percentile":31151.98,"90th_percentile":62784.82},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":17452.69,"10th_percentile":17452.69,"90th_percentile":17452.69,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":19123.04,"10th_percentile":8372.78,"90th_percentile":19788.34,"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":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":10479.23,"10th_percentile":7811.77,"90th_percentile":19197.96,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19235.57,"10th_percentile":18894.71,"90th_percentile":19372.8,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":18213.34,"10th_percentile":18213.34,"90th_percentile":109657.09},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17538.19,"10th_percentile":12313.48,"90th_percentile":19392.57,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":18863.19,"10th_percentile":11672.38,"90th_percentile":19392.58,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":47869.77,"10th_percentile":47869.77,"90th_percentile":47869.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19759.53,"maximum":38076.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38076.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30627.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26675.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":6297.0,"10th_percentile":6297.0,"90th_percentile":6297.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":23523.0,"10th_percentile":15182.0,"90th_percentile":44772.85,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7837.36,"10th_percentile":7837.36,"90th_percentile":7837.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":35232.82,"10th_percentile":14980.0,"90th_percentile":53228.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8481.05,"10th_percentile":6624.04,"90th_percentile":8481.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"26","median_amount":6376.75,"10th_percentile":6376.75,"90th_percentile":7101.62,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"1 through 10","median_amount":15062.0,"10th_percentile":15062.0,"90th_percentile":15062.0,"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":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":20453.17,"10th_percentile":20453.17,"90th_percentile":20453.17},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6447.76,"10th_percentile":6447.76,"90th_percentile":6447.76,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10356.6,"10th_percentile":10356.6,"90th_percentile":10356.6,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15698.74,"10th_percentile":15698.74,"90th_percentile":15698.74,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":43347.47,"10th_percentile":43347.47,"90th_percentile":43347.47,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":33090.39,"10th_percentile":33090.39,"90th_percentile":33090.39},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9966.52,"10th_percentile":9966.52,"90th_percentile":9966.52,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":252.11,"10th_percentile":252.11,"90th_percentile":252.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9756.34,"10th_percentile":9664.29,"90th_percentile":12669.09,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10690.59,"maximum":20600.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20600.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16570.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14432.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":38726.18,"maximum":74625.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60025.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52280.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38726.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4969.76,"10th_percentile":3757.39,"90th_percentile":7029.53,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10068.04,"maximum":19401.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19401.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15605.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13591.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9877.62,"maximum":19034.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19034.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15310.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13334.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9877.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11188.83,"maximum":21560.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21560.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17342.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15104.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19994.35,"maximum":38529.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38529.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30991.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26992.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19994.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14939.92,"10th_percentile":14939.92,"90th_percentile":14939.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15479.9,"10th_percentile":15479.9,"90th_percentile":15479.9,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16468.19,"maximum":31734.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31734.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25525.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22232.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5802.23,"10th_percentile":5802.23,"90th_percentile":5802.23,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":29805.74,"10th_percentile":29805.74,"90th_percentile":29805.74},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14375.59,"maximum":27701.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19407.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21069.76,"maximum":40601.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40601.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32658.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28444.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21069.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11160.22,"maximum":21505.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21505.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15066.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":8083.0,"10th_percentile":8083.0,"90th_percentile":8083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6999.43,"10th_percentile":6999.43,"90th_percentile":6999.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3378.55,"10th_percentile":3378.55,"90th_percentile":3378.55,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":15380.12,"10th_percentile":15380.12,"90th_percentile":30047.18},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":3708.13,"10th_percentile":3708.13,"90th_percentile":3708.13,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6680.99,"maximum":12874.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12874.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10355.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9019.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14561.07,"maximum":28059.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22569.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19657.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14561.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":23523.0,"10th_percentile":23523.0,"90th_percentile":23523.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5986.4,"10th_percentile":5986.4,"90th_percentile":6312.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7740.97,"10th_percentile":7740.97,"90th_percentile":7740.97,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":51277.6,"10th_percentile":51277.6,"90th_percentile":51277.6},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7707.07,"10th_percentile":7707.07,"90th_percentile":7707.07,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2749.9,"10th_percentile":2749.9,"90th_percentile":2749.9,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":4951.16,"10th_percentile":4951.16,"90th_percentile":4951.16,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":30569.22,"10th_percentile":30569.22,"90th_percentile":30569.22},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":40900.85,"10th_percentile":40900.85,"90th_percentile":40900.85},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":27533.12,"10th_percentile":27533.12,"90th_percentile":27533.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17811.96,"maximum":34323.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34323.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27608.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24046.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":6297.0,"10th_percentile":6297.0,"90th_percentile":6297.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"1 through 10","median_amount":3648.17,"10th_percentile":3648.17,"90th_percentile":3648.17},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":7341.0,"10th_percentile":7341.0,"90th_percentile":7591.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4373.61,"10th_percentile":4373.61,"90th_percentile":4373.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":17038.0,"10th_percentile":17038.0,"90th_percentile":17038.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"16","median_amount":6312.27,"10th_percentile":5986.4,"90th_percentile":6312.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":23430.0,"10th_percentile":23430.0,"90th_percentile":23430.0,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"16","median_amount":4746.08,"10th_percentile":4501.06,"90th_percentile":7740.97,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":23233.47,"10th_percentile":17832.47,"90th_percentile":52259.4},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"1 through 10","median_amount":5220.68,"10th_percentile":4951.16,"90th_percentile":5220.68,"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 Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"1 through 10","median_amount":19539.13,"10th_percentile":19539.13,"90th_percentile":24877.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16441.41,"10th_percentile":16441.41,"90th_percentile":16441.41,"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":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"1 through 10","median_amount":6686.03,"10th_percentile":6686.03,"90th_percentile":6686.03}]},{"setting":"inpatient","billing_class":"facility","minimum":9304.4,"maximum":17929.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17929.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12560.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41998.77,"maximum":80931.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80931.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65098.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56698.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41998.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":36725.63,"10th_percentile":36725.63,"90th_percentile":36725.63},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19483.28,"maximum":37544.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37544.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30199.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26302.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19483.28,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12134.0,"maximum":23382.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23382.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18807.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16380.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36833.85,"maximum":70978.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70978.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57092.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49725.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15229.99,"maximum":29348.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29348.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23606.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20560.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19974.62,"maximum":38491.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38491.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30960.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26965.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19974.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36232.48,"10th_percentile":36232.48,"90th_percentile":36232.48,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":38473.61,"maximum":74138.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74138.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59634.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51939.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38473.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20279.48,"maximum":39078.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39078.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31433.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27377.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12734.23,"10th_percentile":12734.23,"90th_percentile":12734.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13545.85,"maximum":26102.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26102.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20996.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18286.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16721.75,"maximum":32222.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32222.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25918.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22574.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9331.04,"maximum":17980.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17980.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14463.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12596.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":16771.09,"10th_percentile":16771.09,"90th_percentile":16771.09,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17185.46,"maximum":33116.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26637.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23200.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":6712.0,"10th_percentile":6712.0,"90th_percentile":6712.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":15779.0,"10th_percentile":15779.0,"90th_percentile":15779.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7168.38,"maximum":13813.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13813.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11110.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9677.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9745.46,"10th_percentile":9745.46,"90th_percentile":16730.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"1 through 10","median_amount":825.81,"10th_percentile":825.81,"90th_percentile":825.81,"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":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7149.44,"10th_percentile":6603.95,"90th_percentile":22013.81,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":27696.04,"10th_percentile":27696.04,"90th_percentile":27696.04},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21736.33,"10th_percentile":21736.33,"90th_percentile":21736.33,"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":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16068.62,"maximum":30964.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30964.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24906.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21692.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16068.62,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"1 through 10","median_amount":10728.0,"10th_percentile":10728.0,"90th_percentile":10728.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6509.55,"10th_percentile":6509.55,"90th_percentile":6509.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":4658.09,"10th_percentile":4658.09,"90th_percentile":4658.09,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7349.53,"10th_percentile":7349.53,"90th_percentile":7349.53,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":25119.42,"10th_percentile":25119.42,"90th_percentile":25119.42},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"1 through 10","median_amount":9203.33,"10th_percentile":9203.33,"90th_percentile":9203.33},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8798.76,"10th_percentile":8798.76,"90th_percentile":8798.76,"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":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8798.21,"10th_percentile":8798.21,"90th_percentile":8798.21,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9050.84,"maximum":17440.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17440.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12218.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"1 through 10","median_amount":12594.0,"10th_percentile":12594.0,"90th_percentile":12594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":17105.0,"10th_percentile":17105.0,"90th_percentile":17105.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5295.78,"10th_percentile":5295.78,"90th_percentile":15104.6,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20768.07,"10th_percentile":20768.07,"90th_percentile":20768.07,"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":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18657.49,"maximum":35952.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35952.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25187.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":9022.0,"10th_percentile":9022.0,"90th_percentile":9022.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10483.4,"maximum":20201.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20201.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16249.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14152.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10483.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7922.41,"10th_percentile":7922.41,"90th_percentile":7922.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6947.48,"10th_percentile":6947.48,"90th_percentile":6947.48,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7386.42,"maximum":14233.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14233.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11448.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9971.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":10637.59,"10th_percentile":10637.59,"90th_percentile":10637.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17854.38,"maximum":34405.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34405.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27674.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24103.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10355.34,"10th_percentile":10355.34,"90th_percentile":10355.34,"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":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":26485.26,"10th_percentile":26485.26,"90th_percentile":26485.26},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10635.34,"maximum":20494.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20494.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16484.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14357.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10635.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":211241.34,"maximum":407062.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":407062.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":285175.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211241.34,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":71361.36,"maximum":137513.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":137513.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110610.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96337.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71361.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32371.4,"maximum":62379.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62379.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50175.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43701.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32371.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":39015.26,"maximum":75182.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75182.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60473.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52670.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39015.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22404.64,"maximum":43173.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43173.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34727.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30246.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22404.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20918.8,"maximum":40310.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40310.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28240.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36393.83,"maximum":70130.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70130.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56410.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49131.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23650.73,"maximum":45574.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36658.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31928.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23650.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":20600.13,"maximum":39696.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39696.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31930.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27810.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15873.27,"maximum":30587.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30587.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21428.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11909.06,"maximum":22948.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22948.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18459.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16077.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13118.64,"maximum":25279.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25279.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20333.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17710.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8158.85,"10th_percentile":8158.85,"90th_percentile":8158.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7111.26,"10th_percentile":7111.26,"90th_percentile":7111.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":5346.82,"10th_percentile":3574.67,"90th_percentile":5346.82,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":3574.66,"10th_percentile":3574.66,"90th_percentile":3574.66,"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":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8492.42,"maximum":16364.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16364.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13163.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11464.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12332.31,"maximum":23764.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23764.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19115.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16648.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6787.55,"maximum":13079.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13079.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9163.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.55,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5926.63,"10th_percentile":5926.63,"90th_percentile":6083.33,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5961.67,"10th_percentile":5961.67,"90th_percentile":5961.67,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6080.15,"maximum":11716.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11716.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9424.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8208.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":67004.47,"maximum":129117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129117.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103856.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90456.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67004.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37720.82,"maximum":72688.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72688.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58467.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50923.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37720.82,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":75773.49,"maximum":146015.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":146015.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102294.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75773.49,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42169.46,"maximum":81260.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81260.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65362.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56928.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42169.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29641.45,"maximum":57119.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45944.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40015.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29641.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27566.6,"maximum":53120.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53120.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42728.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37214.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27566.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15715.41,"maximum":30283.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30283.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24358.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21215.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15715.41,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":7919.13,"10th_percentile":7919.13,"90th_percentile":7919.13,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9873.67,"maximum":19026.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15304.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13329.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9873.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":60988.11,"maximum":117524.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117524.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94531.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82333.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60988.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26615.51,"maximum":51288.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51288.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41254.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26615.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29068.23,"maximum":56014.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56014.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45055.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39242.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.23,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":9011.12,"10th_percentile":9011.12,"90th_percentile":9011.12,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13371.22,"maximum":25766.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25766.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13371.22,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9500.73,"maximum":18307.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18307.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14726.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12825.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13397.85,"maximum":25817.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25817.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20766.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18087.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"1 through 10","median_amount":63742.39,"10th_percentile":63742.39,"90th_percentile":63742.39,"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":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46884.48,"maximum":90346.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90346.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72670.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63294.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46884.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":6583.93,"10th_percentile":6583.93,"90th_percentile":6583.93,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23167.87,"10th_percentile":23167.87,"90th_percentile":23167.87,"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 Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":24850.46,"maximum":47886.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47886.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38518.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24850.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":12920.63,"10th_percentile":12920.63,"90th_percentile":12920.63,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16117.86,"10th_percentile":16117.86,"90th_percentile":16117.86,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17505.12,"maximum":33732.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33732.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27132.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23631.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.12,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":35900.26,"10th_percentile":35900.26,"90th_percentile":35900.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30878.69,"10th_percentile":30878.69,"90th_percentile":30878.69,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":34419.61,"maximum":66326.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66326.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53350.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46466.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34419.61,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8488.23,"10th_percentile":8488.23,"90th_percentile":8488.23,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16810.55,"maximum":32393.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32393.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26056.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22694.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.55,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12426.04,"maximum":23944.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23944.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19260.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16775.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":34.56,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":34.76,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.1,"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":"Gatekeeper HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7209] [Surgical-Per Diem: 7209] [ICU-Per Diem: 7209] [CCU-Per Diem: 7209] [Step Down-Per Diem: 7209] [C-Section-Per Diem: 4623.48 Days: 3 Additional Days: 3360.96] [Normal Vaginal Delivery-Per Diem: 4623.48 Days: 2 Additional Days: 3360.96] [Nursery  Level 1- Boarder-Per Diem: 1301.40] [Nursery  Level 2-Per Diem: 7209] [Nursery  Level 3-Per Diem: 7209] [Nursery  Level 4-NICU-Per Diem: 7209] [Alcohol/ Chemical Dependency-Per Diem: 1558.44] [Psych-Per Diem: 1965.60] [Rehab-Per Diem: 3896.64] [SNF-Per Diem: 1317.60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4007 (%BC): 50] [Bariatric Surgery-Case Rate: 36835.56 Days: 4 Additional Days: 7209] [Cardiac Cath-Per Diem: 10873 Days: 2 Additional Days: 7209] [Cardiac Surgery-Per Diem: 10873 Days: 2 Additional Days: 7209] [Trauma  (%BC): 57.35]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.25,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6512.40] [Surgical-Per Diem: 6512.40] [ICU-Per Diem: 6512.40] [CCU-Per Diem: 6512.40] [Step Down-Per Diem: 6512.40] [C-Section-Per Diem: 4174.20 Days: 3 Additional Days: 3034.8] [Normal Vaginal Delivery-Per Diem: 4174.20 Days: 2 Additional Days: 3034.8] [Nursery  Level 1- Boarder-Per Diem: 1173.96] [Nursery  Level 2-Per Diem: 6512.40] [Nursery  Level 3-Per Diem: 6512.40] [Nursery  Level 4-NICU-Per Diem: 6512.40] [Alcohol/ Chemical Dependency-Per Diem: 1411.56] [Psych-Per Diem: 1773.36] [Rehab-Per Diem: 3517.76] [SNF-Per Diem: 1191.24] [IP High Cost Drugs ($): 0 Charge Threshold 3177 (%BC): 46] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 3177 (%BC): 46] [Bariatric Surgery-Case Rate: 34180.92 Days: 4 Additional Days: 6512.4] [Cardiac Cath-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Cardiac Surgery-Per Diem: 9980.28 Days: 2 Additional Days: 6512.4] [Trauma  (%BC): 58]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 8390] [Surgical-Per Diem: 8390] [ICU-Per Diem: 9843] [CCU-Per Diem: 9843] [C-Section-Per Diem: 6058] [Nursery  Level 1- Boarder-Per Diem: 1116] [Nursery  Level 2-Per Diem: 2905] [Nursery  Level 3-Per Diem: 4247] [Nursery  Level 4-NICU-Per Diem: 9843] [Alcohol/ Chemical Dependency-Per Diem: 1389] [Psych-Per Diem: 1389] [Rehab-Per Diem: 4469] [Bariatric Surgery-Case Rate: 28252 Days: 3 Additional Days: 8421] [Cardiac Cath-Per Diem: 14512] [Cardiac Surgery-Per Diem: 14512] [Trauma-Per Diem: 33142]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5873] [Surgical-Per Diem: 5873] [ICU-Per Diem: 6890] [CCU-Per Diem: 6890] [C-Section-Case Rate: 4241] [Nursery  Level 1- Boarder-Per Diem: 781] [Nursery  Level 2-Per Diem: 2034] [Nursery  Level 3-Per Diem: 2973] [Nursery  Level 4-NICU-Per Diem: 6890] [Alcohol/ Chemical Dependency-Per Diem: 972] [Psych-Per Diem: 972] [Rehab-Per Diem: 3128] [Bariatric Surgery-Case Rate: 19776 Days: 3 Additional Days: 5895] [Cardiac Cath-Per Diem: 10158] [Cardiac Surgery-Per Diem: 10158] [Trauma-Per Diem: 23199]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 7280] [Surgical-Per Diem: 7280] [ICU-Per Diem: 8770] [CCU-Per Diem: 8770] [Step Down-Per Diem: 7861] [C-Section-Per Diem: 6466 Days: 2 Additional Days: 6466] [Normal Vaginal Delivery-Per Diem: 6466 Days: 2 Additional Days: 6466] [Nursery  Level 1- Boarder-Per Diem: 1614] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8280] [Trauma  (%BC): 60.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 7894] [Surgical-Per Diem: 7894] [ICU-Per Diem: 9509] [CCU-Per Diem: 9509] [Step Down-Per Diem: 8519] [C-Section-Per Diem: 6943 Days: 2 Additional Days: 6943] [Normal Vaginal Delivery-Per Diem: 6943 Days: 2 Additional Days: 6943] [Nursery  Level 1- Boarder-Per Diem: 1749] [Nursery  Level 2-Per Diem: 7980] [Nursery  Level 3-Per Diem: 7980] [Nursery  Level 4-NICU-Per Diem: 7980] [IP High Cost Drugs ($): 0 Charge Threshold 5008 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5008 (%BC): 30] [Bariatric Surgery-Case Rate: 35806 Days: 3 Additional Days: 11935] [Cardiac Cath-Per Diem: 8989] [PTCA-Per Diem: 8989] [Trauma  (%BC): 60.30]","count":"1 through 10","median_amount":14980.0,"10th_percentile":14980.0,"90th_percentile":14980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 8189] [Surgical-Per Diem: 8189] [ICU-Per Diem: 9177] [CCU-Per Diem: 9177] [Step Down-Per Diem: 8189] [C-Section-Per Diem: 5317] [Normal Vaginal Delivery-Per Diem: 5317] [Nursery  Level 1- Boarder-Per Diem: 2429] [Nursery  Level 2-Per Diem: 7519] [Nursery  Level 3-Per Diem: 7519] [Nursery  Level 4-NICU-Per Diem: 7519] [Alcohol/ Chemical Dependency-Per Diem: 2279] [Rehab-Per Diem: 4481] [IP High Cost Drugs ($): 0 Charge Threshold 5889 (%BC): 50] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5889 (%BC): 50] [Cardiac Surgery-Per Diem: 13981] [Trauma  (%BC): 73.83] [All Other IP (%BC): 83.34]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":55.74,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"1 through 10","median_amount":8359.53,"10th_percentile":8359.53,"90th_percentile":8359.53,"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":"Community Health Group","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [Thrombophlebitis-Per Diem: 13290] [Medical-Per Diem: 7870] [Surgical-Per Diem: 7870] [ICU-Per Diem: 9689] [CCU-Per Diem: 9689] [Step Down-Per Diem: 8599] [C-Section-Case Rate: 15145] [Normal Vaginal Delivery-Case Rate: 15145] [Nursery  Level 1- Boarder-Per Diem: 2319] [Nursery  Level 2-Per Diem: 9297] [Nursery  Level 3-Per Diem: 9297] [Nursery  Level 4-NICU-Per Diem: 9297] [Psych-Per Diem: 2672] [Rehab-Per Diem: 4943] [IP High Cost Drugs ($): 0 Charge Threshold 8820 (%BC): 34.60] [Bariatric Surgery-Case Rate: 30532] [Cardiac Cath-Per Diem: 13290] [Trauma  (%BC): 69.50] [All Other IP (%BC): 64.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 84.60] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 13974] [Normal Vaginal Delivery-Case Rate: 13974]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Bariatric Gastro Sleeve Revision-Case Rate: 23747] [Bariatric Lap Gastro Sleeve-Case Rate: 17062] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 2994] [Surgical-Per Diem: 2994] [ICU-Per Diem: 3649] [CCU-Per Diem: 3649] [Step Down-Per Diem: 3238] [Rehab-Per Diem: 1861] [Bariatric Surgery-Case Rate: 30532]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhcs.ca.gov/provgovpart/] [Nursery  Level 1- Boarder-Per Diem: 575] [SNF-Per Diem: 750]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":310.9,"additional_payer_notes":"APC"}]}]},{"description":"filters elec/combo vad, rep","code_information":[{"code":"Q0500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.71,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.71,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.9,"additional_payer_notes":"APC"}]}]},{"description":"shwr cov elec/combo vad, rep","code_information":[{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.75,"maximum":1131.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.75,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1131.76,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":951.31,"additional_payer_notes":"APC"}]}]},{"description":"mobility cart pneum vad, rep","code_information":[{"code":"Q0502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.39,"maximum":1440.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.39,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1440.88,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1211.15,"additional_payer_notes":"APC"}]}]},{"description":"battery pneum vad replacemnt","code_information":[{"code":"Q0503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1562.84,"maximum":2881.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1562.84,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2881.88,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2422.4,"additional_payer_notes":"APC"}]}]},{"description":"pwr adpt pneum vad, rep veh","code_information":[{"code":"Q0504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.68,"maximum":1520.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.68,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1520.71,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1278.25,"additional_payer_notes":"APC"}]}]},{"description":"Lith-ion batt elec/pneum VAD","code_information":[{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.54,"maximum":1892.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1026.54,"additional_payer_notes":"APC"},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1892.94,"additional_payer_notes":"APC"},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1591.14,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate structure, a service that is distinct because it was performed on a separate organ/structure","code":"XS","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","code":"CQ","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","code":"CO","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Priority Select Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Gatekeeper HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Whole Health Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Community Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Scan Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Health Plan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Select Plus Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper PPO","description":"The modified price is presented in the standard charge value."}]}]}